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Shawahna R, Mukhaimer Y, Hawwari H, Barham M, Jaber M, Maqboul I, Hijaz H. Availability of Pediatric Services and Equipment in Emergency Departments: A Multicenter Study in Resource-Limited Settings. Pediatr Emerg Care 2024; 40:e126-e132. [PMID: 38739845 DOI: 10.1097/pec.0000000000003215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
OBJECTIVE This study was conducted to assess the availability of equipment and supplies in the emergency departments of the hospitals in the West Bank of Palestine. METHODS This study was conducted in a cross-sectional design using a data collection form that was specifically developed for this study. The standardized data collection form contained a detailed list of all essential pediatric emergency equipment and supplies. RESULTS This study was conducted in a total of 30 hospitals all across the West Bank of Palestine. The median number of patients visiting the emergency department per day was 115.0, the median number of patients admitted to the hospital per day was 14.5, and the median number of pediatric patients visiting the emergency department per day was 6.0. The median number of pediatricians in the hospital was 4.0, the median number of pediatricians in the emergency department was 1.0, the median number of nurses in the hospital was 75.0, and the median number of nurses in the emergency department was 8.5. Both governmental and private hospitals lacked the equipment and supplies needed for monitoring, gaining vascular access, airway management, resuscitation medications, cervical immobilization equipment, and other equipment and supplies. CONCLUSIONS Decision and policymakers might use the findings reported in this study to allocate resources to restock and increase the availability of pediatric emergency equipment and supplies. More studies are still needed to compare the outcomes of patients before and after restocking and increasing the availability of pediatric emergency equipment and supplies.
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Affiliation(s)
| | - Yara Mukhaimer
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University
| | - Hiba Hawwari
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University
| | - Mo'men Barham
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University
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AlSulami AF, AlGhamdi MA, Gaafar AM, Hamam AF. More Is Actually Less: Practitioners' Perspective of Unnecessary Medical Testing in Saudi Arabian Emergency Departments. Cureus 2024; 16:e62384. [PMID: 39006660 PMCID: PMC11246772 DOI: 10.7759/cureus.62384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2024] [Indexed: 07/16/2024] Open
Abstract
Background The overuse of medical testing, be it ancillary testing or imaging, has been identified as a problem in all healthcare systems in the world. As the Kingdom of Saudi Arabia marches towards the 2030 vision of healthcare transformation, we have sought to get a perspective on medically unnecessary tests being conducted in Saudi Arabian emergency departments (EDs), the reasons behind this phenomenon, and possible solutions to it. Methods This is a cross-sectional survey among emergency medicine physicians (EMPs) working in Saudi Arabian EDs, taken through a self-filled online questionnaire, about their ordering habits, what they believe to be unnecessary testing in their practice, the practice of their colleagues, and other Saudi EMPs as a whole. Subjects have also been asked about the reasons why such practices are occurring and possible solutions to reduce such overuse of unnecessary tests in Saudi EDs. Results A total of 182 EMPs were surveyed from the different regions of the Kingdom, and CT head for patients presenting with asymptomatic stroke, and asymptomatic TBI were the most overused scans (both 44%). The most overused advanced body imaging was CT kidney-ureters-bladder (KUB) at 41.5%, while the most overused ancillary tests were complete blood count (CBC) and liver transaminases. The most common reason for the practice was found to be fear of medicolegal proceedings (70.9%). Continuous education of EMPs and increasing ED staffing were found to be the most helpful solutions to reduce unnecessary testing in the ED (70.9% and 67%, respectively). Conclusion It is clear from our data that overuse of medical tests and imaging is still a prominent practice. CT head in asymptomatic patients seems to be the most commonly overused imaging in Saudi EDs. Ancillary testing and unnecessary ordering of CBCs and transaminases seem to stem from fear of EMPs from legal consequences. More control over medical test ordering needs to be exercised to reduce these practices.
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Affiliation(s)
| | | | - Amro M Gaafar
- Emergency Medicine, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Anas F Hamam
- Emergency Medicine, King Fahad Armed Forces Hospital, Jeddah, SAU
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Khojah I, Muthaffar O, Alalawi H, Alyazidi A, Alghamdi M, Alharbi O, Almuharib L, Salem M. Neuro-pediatric emergencies: clinical profile and outcomes. J Med Life 2024; 17:432-441. [PMID: 39071508 PMCID: PMC11282903 DOI: 10.25122/jml-2023-0476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/16/2024] [Indexed: 07/30/2024] Open
Abstract
Pediatric neurological emergencies are a significant concern, often leading to high rates of admission to pediatric intensive care units and increased mortality rates. In Saudi Arabia, the emergency department (ED) is the main entry point for most patients in the healthcare system. This study aimed to provide a comprehensive overview of pediatric neurology visits to the ED, analyzing patient demographics, clinical presentations, and outcomes. The retrospective study was conducted at a large tertiary care center and examined 960 pediatric patients with neurological emergencies out of 24,088 pediatric ED visits. The study population consisted mainly of male participants (56.5%) and 43.5% female participants, with a mean age of 5.29 ± 4.19 years. School-age children (6-12 years) represented the largest population group (29.1%), and over a third of patients were triaged as 'resuscitation' (n = 332, 34.6%). Seizures (n = 317, 33.0%) and postictal states (n = 187, 19.5%) were the most common reasons for seeking emergency care, accounting for over half of all cases. There were statistically significant differences in provisional diagnosis and chief complaints across different age groups (P >0.001 and P <0.001, respectively). The most common outcome was discharge (n = 558; 58.1%), and the mean length of stay was 10.56 ± 20.33 hours. Neuro-emergencies in pediatrics are a concern and a leading cause of mortality, morbidities, and increased hospital visits. The observed variations in presentation and outcomes across age groups further emphasize the importance of tailored approaches.
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Affiliation(s)
- Imad Khojah
- Department of Emergency Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Osama Muthaffar
- Department of Pediatrics, Division of Pediatrics Neurology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hassan Alalawi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Anas Alyazidi
- Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Maha Alghamdi
- Department of Internal Medicine, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ohud Alharbi
- Faculty of Medicine, Qassim University, Al-Mulida, Saudi Arabia
| | - Latifa Almuharib
- National Guard Riyadh, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
| | - Mayar Salem
- Faculty of Medicine, Qassim University, Al-Mulida, Saudi Arabia
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Khan A, Alojayri RM, Alhoseini N, AlZahrani F, Dammas SS, Alothmani M, Almanjomi M. The Prevalence and Utilization of Prehospital IV Access in Critically Ill Patients in the Emergency Department. Cureus 2023; 15:e44111. [PMID: 37750158 PMCID: PMC10518188 DOI: 10.7759/cureus.44111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Despite the pivotality of emergency medical services (EMS) in prehospital care for patient stabilization, prehospital intravenous (IV) access, a standard practice, remains an ambiguity in Saudi Arabia in terms of its prevalence of placement, justification, and utilization. OBJECTIVES In this study, we aim to estimate the prevalence and utilization rate of prehospital IV access placement in patients transported to King Khalid University Hospital (KKUH) Emergency Medicine Department in Riyadh by EMS and determine the relationship between the prevalence and utilization rate of prehospital IV access in Canadian Triage and Acuity Scale (CTAS) levels 1 and 2 in trauma and non-trauma patients. METHODS This observational cross-sectional study was conducted over six months. A total of 181 cases of CTAS levels 1 and 2 adult patients were included. Data were collected by trained nurses using convenient sampling through an author-developed questionnaire. RESULTS The prevalence of prehospital IV line placement was 28.7%, with a utilization rate of 50%, and was notably higher among CTAS level 1 cases (69.2%). Additionally, trauma cases had a higher prevalence of prehospital IV access (53.5%) compared to medical cases (odds ratio (OR): 4.73, 95% confidence interval (CI): 4.73, 4.73, p<0.05). Among patients with prehospital IV lines, the majority (92.3%) were patent and functional. Upon arrival, 73.1% of patients had their prehospital IV line replaced, with hospital protocol being the most common reason for the replacement (73.7%). CONCLUSION A minority of the patients had prehospital vascular access, and of those, half remained unused. Trauma cases and CTAS level 1 patients had a higher prevalence and utilization of prehospital IV access. Furthermore, trauma cases were more associated with prehospital IV access establishment and utilization.
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Affiliation(s)
- Anas Khan
- Emergency Medicine, King Saud University, Riyadh, SAU
| | | | | | | | - Saad S Dammas
- Emergency Medicine, King Saud University, Riyadh, SAU
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Al-Wathinani AM, Barten DG, Alsahli H, Alhamid A, Alghamdi W, Alqahtani W, Alghamdi R, Aljuaid M, Albaqami NA, Goniewicz K. The Right to Refuse: Understanding Healthcare Providers' Perspectives on Patient Autonomy in Emergency Care. Healthcare (Basel) 2023; 11:1756. [PMID: 37372874 DOI: 10.3390/healthcare11121756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/07/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
Healthcare providers in prehospital care and emergency departments are often at the frontline of medical crises, facing a range of ethical dilemmas, particularly when it comes to patients refusing treatment. This study aimed to delve into the attitudes of these providers toward treatment refusal, unearthing the strategies they employ in navigating such challenging situations while actively working in prehospital emergency health services. Our findings showed that, as the participants' age and experience increased, so did their inclination to respect patient autonomy and avoid persuading them to change their decision about treatment. It was noted that doctors, paramedics, and emergency medical technicians demonstrated a deeper understanding of patients' rights than other medical specialists. However, even with this understanding, the prioritization of patients' rights tended to diminish in life-threatening situations, giving rise to ethical dilemmas. This underlines the complexity of balancing the healthcare professionals' responsibilities and the patients' autonomy, which can generate ethically challenging scenarios for those working in emergency healthcare. By investigating these attitudes and experiences, this study seeks to foster a more profound understanding of the ethical quandaries faced by emergency healthcare providers. Our ultimate aim is to contribute to the development of effective strategies that support both patients and professionals in managing these tough circumstances.
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Affiliation(s)
- Ahmed M Al-Wathinani
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Dennis G Barten
- Department of Emergency Medicine, VieCuri Medical Center, 5912 BL Venlo, The Netherlands
| | - Hind Alsahli
- Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Riyadh 11211, Saudi Arabia
| | - Anfal Alhamid
- Primary Care Clinic and Emergency Department, Dental University Hospital-KSUMC, King Saud University, Riyadh 11451, Saudi Arabia
| | - Waad Alghamdi
- Department of Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard, Riyadh 1154, Saudi Arabia
| | - Wadha Alqahtani
- Department of Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard, Riyadh 1154, Saudi Arabia
| | - Raghad Alghamdi
- Department of Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard, Riyadh 1154, Saudi Arabia
| | - Mohammad Aljuaid
- Department of Health Administration, College of Business Administration, King Saud University, Riyadh 11541, Saudi Arabia
| | - Nawaf A Albaqami
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh 11451, Saudi Arabia
| | - Krzysztof Goniewicz
- Department of Security Studies, Polish Air Force University, 08-521 Dęblin, Poland
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Yousef AA, Al Qahtani MH, Al-Mutairi AK, AlQurashi FO, AlOmar RS, AlShamlan NA, Al Shammari MA, Yousef HA. Factors Affecting Length of Stay in Pediatric Emergency Department in a Teaching Hospital in Saudi Arabia. Med Arch 2023; 77:268-275. [PMID: 37876560 PMCID: PMC10591245 DOI: 10.5455/medarh.2023.77.268-275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 07/24/2023] [Indexed: 10/26/2023] Open
Abstract
Background Decreasing the number of Emergency Department patient visits for treatment, especially in non-urgent cases, is an international healthcare goal. The same applies for pediatric emergency rooms where the utilization of ED is much more than adults. Objective We aim to measure the length of stay for all pediatric patients and examine the factors influencing it. Methods A retrospective chart review study was conducted at the pediatric ED of King Fahd Hospital in the Eastern Province of Saudi Arabia. The study included all patients presented to the pediatric ED, between January 1, 2018, and December 31, 2018, aged from 1 day to < 14 years old. Data included patient's age, sex, season in which the patient presented in, chief complaint, time of presentation, and whether admission to the hospital ward was collected. Results The total number of patients was 37,613. The median LOS was 100, interquartile range (IQR) = 53 - 272 minutes. Male pediatric patients were (55.12%). Among all patients, (32.04%) were toddlers, followed by school aged children (25.05%). The ER received more patients during the winter months followed by summer (32.92% and 24.72%, respectively). Fever was the most common complaint for all patients combined. For prolonged LOS patients, the most common complaints were respiratory related (23.44%). Pre-school children and school aged children were found to have a 5.49% and a 7.93% increased LOS when compared to toddlers (95% CI = 2.52 - 8.53, and 95% CI = 5.01 - 10.93, respectively). Summer was associated with a statistically significant increased LOS (% change = 28.92, 95% CI = 25.53 - 32.40). Morning shift was found to have a 7.89% increased LOS when compared to the evening shift. The highest increase in LOS was attributed to haematology related complaints (% change = 108.32, 95% CI = 85.69 - 133.71). Conclusion Several pediatric LOS predicting factors have been identified; morning arrival, and presentation during summertime. Systemic factors such as staffing, and infrastructure can be modified and may affect the length of stay of patients. The implementation of these strategies and the evaluation of their impact on the length of stay in the pediatric emergency department require further investigation.
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Affiliation(s)
- Abdullah A. Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Mohammed H. Al Qahtani
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Abdullah K. Al-Mutairi
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Faisal O. AlQurashi
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
- King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Reem S. AlOmar
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nouf A. AlShamlan
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Malak A. Al Shammari
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hannen A. Yousef
- Department of Family and Community Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Ali SNAH, Farah RI, Alhariqi S. Knowledge and Attitudes of Saudi Medical Students about Emergency Management of Traumatic Dental Injuries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14249. [PMID: 36361130 PMCID: PMC9654410 DOI: 10.3390/ijerph192114249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
Several studies indicate that physicians lack emergency management knowledge concerning traumatic dental injuries (TDIs), emphasizing the fact that medical students are not taught about this topic. This study aimed to assess the basic knowledge and attitudes of medical students in Saudi Arabia about emergency TDI management. This cross-sectional study recruited a convenience sample of medical students in their clinical years through social networking sites and asked them to answer a pretested internationally accepted questionnaire that included demographic questions, two case scenarios about crown fractures and avulsion of permanent teeth, and self-assessment questions. The data were analyzed statistically using descriptive statistics and the chi-squared test (p < 0.05). A total of 761 medical students responded. Only 5.8% of the students reported receiving information about TDIs in their curriculum. Medical students, mainly those ready to graduate, were more knowledgeable of the emergency management of a crown fractured permanent tooth than an avulsed permanent tooth (p < 0.0001). However, more than half of the students were unable to differentiate between a primary versus permanent fractured tooth and would manage an avulsed primary or permanent tooth similarly. Regarding students' attitudes, less than one-quarter of the students (13.5%) were confident about diagnosing TDIs and/or providing emergency management when required (18.1%). Furthermore, only about one-tenth of the students (9.3%) were satisfied with their self-perceived knowledge, and most (71%) reported needing further education about the topic. Medical students in Saudi Arabia have insufficient knowledge about the emergency management of TDIs. Gaps in students' knowledge of emergency management of avulsion injury were identified in addition to their low confidence level to either diagnose or immediately treat TDIs if required. Students felt dissatisfied with their current knowledge level, this being most prominent among graduating students. There is a need to elaborate the undergraduate medical curriculum in Saudi Arabia to include emergency management of TDIs.
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Affiliation(s)
- Sanaa N. Al-Haj Ali
- Department of Orthodontics and Pediatric Dentistry, College of Dentistry, Qassim University, Buraydah 52571, Qassim, Saudi Arabia
| | - Ra’fat I. Farah
- Department of Prosthetic Dental Sciences, College of Dentistry, Qassim University, Buraydah 52571, Qassim, Saudi Arabia
| | - Serene Alhariqi
- College of Dentistry, Qassim University, Buraydah 52571, Qassim, Saudi Arabia
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Alrumayh AA, Mubarak AM, Almazrua AA, Alharthi MZ, Alatef DF, Albacker TB, Samarkandy FM, Alsofayan YM, Alobaida M. Paramedic Ability in Interpreting Electrocardiogram with ST-segment Elevation Myocardial Infarction (STEMI) in Saudi Arabia. J Multidiscip Healthc 2022; 15:1657-1665. [PMID: 35959233 PMCID: PMC9359379 DOI: 10.2147/jmdh.s371877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/20/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate paramedic ability in recognizing 12-lead Electrocardiogram (ECG) with ST-segment Elevation myocardial infarction (STEMI) in Saudi Arabia. Methods This is a quantitative exploratory cross-sectional study using an electronic survey of paramedics was conducted between June and September 2021. The survey included demographics, educational and clinical experiences, and multiple 12-lead ECG strip questions to assess participants’ ability to recognize STEMI. We reported the overall sensitivity, specificity, and correct proportions with 95% Confidence Intervals (CI). Results Eighty-four paramedics completed the survey, and 65% of them were between 24 and 29 years old, with a median, of three years of field experience. Overall sensitivity and specificity were 58.39% (95% CI, 50.4% to 66.1%) and 29.01% (95% CI, 25.15% to 33.1%), respectively. In total, 67.1% correctly identified inferior STEMI, whereas only 50% correctly identified lateral STEMI. Both STEMIs were correctly identified by 41%, and the majority misinterpreted STEMI mimics (ECG rhythms with similar ECG morphology to STEMI). The proportion who correctly recognized left bundle branch block was 14.8%, pericarditis was 10.9%, and ventricular pacing was 1.4%. However, almost third of participants correctly identified right bundle branch block (32.9%) and left ventricle hypertrophy (30.7%). Overall, there was no correlation between the correct ECG interpretation of STEMIs and educational and clinical experiences. Conclusion Paramedics were able to identify STEMI events in prehospital settings with moderate sensitivity and low specificity with limited ability to differentiate between STEMI and STEMI mimics. Therefore, additional training in ECG interpretation could improve their clinical decision-making, and to ensure that proper care and treatment is provided. Further research on a large, representative sample of paramedics across the country could provide more definitive evidence to establish a greater degree of accuracy in detecting STEMI in prehospital settings.
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Affiliation(s)
- Abdullah A Alrumayh
- Department of Basic Sciences, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah M Mubarak
- Department of Basic Sciences, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Abdulkarim A Almazrua
- Department of Aviation and Marine, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Musab Z Alharthi
- Department of Accident and Trauma, Prince Sultan Bin AbdulazizCollege for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Deem F Alatef
- Department of Emergency Medical Services and Disaster Management, King Saud Medical City, Riyadh, Saudi Arabia
| | - Turki B Albacker
- Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Fahad M Samarkandy
- Department of Operational Affairs, Saudi Red Crescent Authority, Riyadh, Saudi Arabia
| | - Yousef M Alsofayan
- Executive Directorate of Medical Affairs, Saudi Red Crescent Authority, Riyadh, Saudi Arabia
| | - Muath Alobaida
- Department of Basic Sciences, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
- Correspondence: Muath Alobaida, Department of Basic Sciences, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia, Email
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Alobaid AM, Mobrad A, Gosling C, McKenna L, Williams B. Saudi Arabian Community Perceptions on Saudi Female Paramedics: A Cross-Sectional Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:137-147. [PMID: 35173513 PMCID: PMC8841242 DOI: 10.2147/amep.s347363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Although emergency medical services (EMS) stakeholders acknowledge the need for both male and female paramedics in the EMS field, the Saudi EMS system is currently only staffed by male paramedics and emergency medical technicians (EMTs) working in EMS organisations. AIM To understand and explore the Saudi Arabian community's perceptions on engaging Saudi female paramedics in the EMS workforce. MATERIAL AND METHODS This was a cross-sectional survey design using convenience sampling of the public in Riyadh city by self-administered English and Arabic language questionnaires. Questionnaire validity was assessed by face and content validity. RESULTS Of the 3603 surveys distributed, 3132 were returned (87% completion response rate). Most respondents were aged between 18 and 29 years (n = 1308, 41%), and the sex distribution was (n = 1646, 52.6%) male and (n = 1486, 47.4%) female. Overall, 77% (n = 2412) of the respondents supported the need for female paramedics in Saudi Arabian ambulance services, and 74.8% (n = 2343) preferred that female paramedics treated female patients. CONCLUSION This is the first public study to explore Saudi public perceptions about female paramedics in EMS in the Riyadh region, Saudi Arabia. The Saudi public is supportive of female paramedics being employed as paramedics in the country. Moreover, significant differences in perceptions were evidenced in the sex groups over any other factors.
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Affiliation(s)
- Abdullah Mohammed Alobaid
- Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences Monash University, Melbourne, Victoria, Australia
| | - Abdulmajeed Mobrad
- Department of Emergency Medical Services, Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Cameron Gosling
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences Monash University, Melbourne, Victoria, Australia
| | - Lisa McKenna
- La Trobe University, School of Nursing and Midwifery, Melbourne, Victoria, Australia
| | - Brett Williams
- Department of Paramedicine, Faculty of Medicine, Nursing and Health Sciences Monash University, Melbourne, Victoria, Australia
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Alenazi A, Alotaibi B, Saleh N, Alshibani A, Alharbi M, Aljerian N, Alharthy N, Alsomali S. Perception and success rate of using advanced airway management by hospital-based paramedics in the Kingdom of Saudi Arabia. Br Paramed J 2021; 6:24-30. [PMID: 34970079 DOI: 10.29045/14784726.2021.12.6.3.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective The study aimed to measure the success rate of pre-hospital tracheal intubation (TI) and supraglottic airway devices (SADs) performed by paramedics for adult patients and to assess the perception of paramedics of advanced airway management. Method The study consisted of two phases: phase 1 was a retrospective analysis to assess the TI and SADs' success rates when applied by paramedics for adult patients aged >14 years from 2012 to 2017, and phase 2 was a distributed questionnaire to assess paramedics' perception of advanced airway management. Result In phase 1, 24 patients met our inclusion criteria. Sixteen (67%) patients had TI, of whom five had failed TI but then were successfully managed using SADs. The TI success rate was 69% from the first two attempts compared to SADs (100% from first attempt). In phase 2, 63/90 (70%) paramedics responded to the questionnaire, of whom 60 (95%) completed it. Forty-eight (80%) paramedics classified themselves to be moderately or very competent with advanced airway management. However, most of them (80%) performed only 1-5 TIs or SADs a year. Conclusion Hospital-based paramedics (i.e. paramedics who are working at hospitals and not in the ambulance service, and who mostly respond to small restricted areas in Saudi Arabia) handled few patients requiring advanced airway management and had a higher competency level with SADs than with TI. The study findings could be impacted by the low sample size. Future research is needed on the success rate and impact on outcomes of using pre-hospital advanced airway management, and on the challenges of mechanical ventilation use during interfacility transfer.
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Affiliation(s)
- Amani Alenazi
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS)
| | | | | | | | - Meshal Alharbi
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS)
| | | | - Nesrin Alharthy
- King Saud bin Abdulaziz University for Health Sciences (KSAU-HS)
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Moafa HN, van Kuijk SMJ, Moukhyer ME, Alqahtani DM, Haak HR. Non-Conveyance Due to Patient-Initiated Refusal in Emergency Medical Services: A Retrospective Population-Based Registry Analysis Study in Riyadh Province, Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179252. [PMID: 34501841 PMCID: PMC8431479 DOI: 10.3390/ijerph18179252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/25/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Abstract
This research study aimed to investigate the association between demographic and operational factors and emergency medical services (EMS) missions ending in non-conveyance (NC) due to patient-initiated refusal (PIR). We conducted a retrospective population-based registry study by analyzing 67,620 EMS missions dispatched to the scene during 2018 in the Riyadh province. First, the number and percentages of conveyances statuses were calculated. Then, using crude and adjusted linear and logistic regression analysis, we determined which characteristics were predictors of NC due to PIR. We found that 23,991 (34.4%) of missions ended in NC due to PIR, and 5969 ended in EMS-initiated refusal (8.6%). NC rates due to PIR were higher for women, adults, for missions in Riyadh city, during nighttime, for medical emergencies, and for advanced life support (ALS) crews. We also found the following additional predictors significantly associated with the odds of NC due to PIR in crude regression analyses: age category, geographical location, EMS-shift, time of call, emergency type, and response time. We conclude that the NC rate represents half of all missions for patients requesting EMS, and the rate in Riyadh city has increased compared to previous studies. Most NC cases occur for the highest urgency level of medical emergency type in Riyadh city during the nighttime with ALS crews. NC due to PIR involves younger patients more than elderly, and females more than males. This study’s findings have provided empirical evidence that indicate that conducting further studies involving EMS providers, patients, and the public to identify precise and detailed reasons is required.
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Affiliation(s)
- Hassan N. Moafa
- Department of Health Services Management, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan 82817 2820, Saudi Arabia
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
- Correspondence: or ; Tel.: +31-615-373-733
| | - Sander M. J. van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands;
| | - Mohammed E. Moukhyer
- Department of Academic Development and Quality, Faculty of Applied Medical Sciences, Jazan University, Jazan 82511, Saudi Arabia;
| | - Dhafer M. Alqahtani
- Department of Electronic Transaction Management, Saudi Red Crescent Authority, Ministry of Health, Riyadh 13251-8261, Saudi Arabia;
| | - Harm R. Haak
- Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, 6229 GT Maastricht, The Netherlands;
- Department of Internal Medicine, Maxima Medisch Centre, 5631 BM Eindhoven, The Netherlands
- Department of Internal Medicine, Maastricht University Medical Centre, 6229 HX Maastricht, The Netherlands
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Al Nhdi N, Al Asmari H, Al Thobaity A. Investigating Indicators of Waiting Time and Length of Stay in Emergency Departments. Open Access Emerg Med 2021; 13:311-318. [PMID: 34295196 PMCID: PMC8291870 DOI: 10.2147/oaem.s316366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 07/07/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate potential indicators of patients' waiting time and length of stay in emergency departments (ED) at the Ministry of Health (MOH) hospitals in order to determine the causes of delayed patient care and to recommend clinical implications to achieve a better ED system. Materials and Methods This exploratory study was conducted in the EDs at four tertiary hospitals of MOH. A random sample of 1360 people was tested from December 2019 to February 2020. Data included patient Canadian Triage Acuity and System (CTAS) level, registration time, triage time, physician examination time, decision time, and disposition time. Descriptive statistics, multivariate analysis, multiple linear regression analysis and Pearson correlation were used according to SPSS (version 24). Results The findings showed that 89.6% of total emergency patients were categorized as levels 3, 4 and 5. Around 73.5% of emergency patients stayed less than 4 hours due to registration or triage to disposition, while 26.5% of those patients stayed more than 4 hours. Conclusion The majority of patients' total stay in EDs was less than 4 hours. According to ED international standard of length of stay, this is appropriate. The highest effective indicator in total length of stay was the decision to disposition time in EDs.
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Affiliation(s)
- Nojoud Al Nhdi
- Nursing Department, Applied Medical Sciences, Taif University, Taif, Saudi Arabia.,Nursing Department, Health directorate in Jeddah, East Jeddah Hospital, Jeddah, Saudi Arabia
| | - Hajar Al Asmari
- Nursing Department, Applied Medical Sciences, Taif University, Taif, Saudi Arabia
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13
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AlOmar RS, AlShamlan NA, AlAmer NA, AlThumairi AA, Almir BM, Aldawood HA, Bukhamsin TH, Alqahtani HA, Al Shammari MA. Perceived Barriers to Primary Care Services Utilization and its Associations with Overall Satisfaction of Patients in Saudi Arabia: A Cross-Sectional Questionnaire-Based Study. J Prim Care Community Health 2021; 12:21501327211014065. [PMID: 33957808 PMCID: PMC8114241 DOI: 10.1177/21501327211014065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Primary care plays an integral role in modern healthcare systems. More so in a country that is currently undergoing a reform of its health system. Their remains barriers that hinder patients from seeking medical assistance from primary physicians. This study aims to examine the overall satisfaction of patients toward Primary Healthcare Centers (PHCs) in Saudi Arabia, as well as its association with potential barriers from a sample of patients who presented at the emergency department (ED) for non-urgent cases. Methods: This cross-sectional study sampled 403 patients from King Fahd Hospital of the University. A piloted questionnaire was utilized that included questions on sociodemographics, satisfaction of PHCs, as well as organizational, socioeconomic, access, and patient-doctor relationship barriers using a Likert-scale item response. Chi-squared and Fisher’s Exact tests were used to compare categorical variables, and multivariable logistic regression was used to assess the association between overall satisfaction and all factors and barriers. Results: The sample consisted of 48.1% males and 51.9% females. Only 5.2% of the patients were hospitalized. Of the total sample, 28.3% reported being always satisfied with PHC services. The most reported barriers were organizational barriers and socioeconomic barriers. The regression analysis found that being a female, highly educated, have high organizational, and patient-doctor relationship were independent predictors for low overall satisfaction with PHCs. Conclusion: Findings from this study should allow healthcare planners and policy makers to reduce the impact of these barriers by finding solutions that would target them. This may include strictly implementing policies such as proper implementing of triaging in EDs as well as promoting services that are being provided free of charge at these centers.
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Affiliation(s)
- Reem S AlOmar
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Naheel A AlAmer
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Bayan M Almir
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Heba A Aldawood
- First Health Cluster in Eastern Province, Dammam, Saudi Arabia
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14
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Al-Qahtani MH, Yousef AA, Awary BH, Albuali WH, Al Ghamdi MA, AlOmar RS, AlShamlan NA, Yousef HA, Motabgani S, AlAmer NA, Alsawad KM, Altaweel FY, Altaweel KS, AlQunais RA, Alsubaie FA, Al Shammari MA. Characteristics of visits and predictors of admission from a paediatric emergency room in Saudi Arabia. BMC Emerg Med 2021; 21:72. [PMID: 34154525 PMCID: PMC8215860 DOI: 10.1186/s12873-021-00467-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 06/04/2021] [Indexed: 01/05/2023] Open
Abstract
Background The Emergency Room (ER) is one of the most used areas in healthcare institutions. Problems with over utilisation and overcrowding have been reported worldwide. This study aims at examining the characteristics of paediatric ER visits, the rate of hospital admissions and its associated predictors at King Fahd Hospital of the University in the Eastern Province of Saudi Arabia. Methods This is a retrospective, medical record-based study. Variables included gender, age group, nationality, complaints, Triage level, shifts and seasons. Descriptive statistics were reported as frequencies/percentages. P-values were obtained through a Chi-Squared test while unadjusted and adjusted odds ratios were estimated by binary logistic regression, where admission was considered as the outcome. Results The total number of paediatric patients included was 46,374, and only 2.5% were admitted. Males comprised 55.4% while females comprised 44.6%. The most common age group were toddlers, and 92.4% of the total sample were Saudis. The most common complaint was fever (26.9%) followed by respiratory symptoms (24.9%). Only 7 patients (0.02%) were classified as triage I (Resuscitation), and most were triage IV (Less urgent) (71.0%). Most visits occurred during the winter months. Adjusted ORs showed that neonates had higher odds of admission (OR = 3.85, 95%CI = 2.57–5.76). Moreover, those presenting with haematological conditions showed an OR of 65.49 (95%CI = 47.85–89.64), followed by endocrine conditions showing an OR of 34.89 (95%CI = 23.65–51.47). Triage I had a very high odds of admission (OR = 19.02, 95%CI = 2.70–133.76), whereas triage V was associated with a very low odds of admission (OR = 0.30, 95%CI = 0.23–0.38). Conclusions A low rate of hospital admission was found in comparison with other rates worldwide. This was mostly attributed to an alarmingly high number of non-urgent ER visits. This further emphasises the problem with improper use of ER services, as these cases should be more appropriately directed towards primary healthcare centres. Further studies to examine the impact of prioritising patients in the ER based on the identified predictors of hospital admission, in addition to the standard triage system, are suggested.
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Affiliation(s)
- Mohammad H Al-Qahtani
- Department of Paediatrics, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Abdullah A Yousef
- Department of Paediatrics, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Bassam H Awary
- Department of Paediatrics, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Waleed H Albuali
- Department of Paediatrics, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Mohammed A Al Ghamdi
- Department of Paediatrics, Imam Abdulrahman Bin Faisal University, College of Medicine, Dammam, Saudi Arabia.,King Fahd Hospital of the University, Al-Khobar, Saudi Arabia
| | - Reem S AlOmar
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia.
| | - Nouf A AlShamlan
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia
| | - Haneen A Yousef
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia
| | - Sameerah Motabgani
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia
| | - Naheel A AlAmer
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia
| | - Kawthar M Alsawad
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah Y Altaweel
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Kawther S Altaweel
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Roaya A AlQunais
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Fatima A Alsubaie
- College of Medicine, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Malak A Al Shammari
- Department of Family and Community Medicine, Imam Abdulrahman Bin University, Dammam, Saudi Arabia
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15
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Anzan M, Alwhaibi M, Almetwazi M, Alhawassi TM. Prescribing errors and associated factors in discharge prescriptions in the emergency department: A prospective cross-sectional study. PLoS One 2021; 16:e0245321. [PMID: 33434202 PMCID: PMC7802932 DOI: 10.1371/journal.pone.0245321] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 12/29/2020] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Evidence regarding the prevalence of medication prescribing errors (PEs) and potential factors that increase PEs among patients treated in the emergency department (ED) are limited. This study aimed to explore the prevalence and nature of PEs in discharge prescriptions in the ED and identify potential risk factors associated with PEs. METHODS This was a prospective observational cross-sectional study in an ambulatory ED in a tertiary teaching hospital. Data were collected for six months using a customized reporting tool. All patients discharged from ED with a discharged prescription within the study period were enrolled in this study. RESULTS About 13.5% (n = 68) of the 504 prescriptions reviewed (for 504 patients) had at least one error. Main PEs encountered were wrong dose (23.2%), wrong frequency (20.7%), and wrong strength errors (14.6%). About 36.8% of identified PEs were related to pediatric prescriptions, followed by the acute care emergency unit (26.5%) and the triage emergency unit (20.6%). The main leading human-related causes associated with PEs were lack of knowledge (40.9%) followed by an improper selection from a computer operator list (31.8%). The leading contributing systems related factors were pre-printed medication orders (50%), lack of training (31.5%), noise level (13.0%), and frequent interruption of prescriber and distraction (11.1%). Prescribers' involved with the identified errors were resident physicians (39.4%), specialists (30.3%), and (24.4%) were made by general practitioners. Physicians rejected around 12% of the pharmacist-raised recommendations related to the identified PEs as per their clinical judgment. CONCLUSION PEs in ED setting are common, and multiple human and systems-related factors may contribute to the development of PEs. Further training to residents and proper communication between the healthcare professionals may reduce the risk of PEs in ED.
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Affiliation(s)
- Mona Anzan
- Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Monira Alwhaibi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mansour Almetwazi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Tariq M. Alhawassi
- Pharmacy Services, King Saud University Medical City, Riyadh, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
- Medication Safety Research Chair, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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16
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Alsulimani LK, Al-Otaiby FM, Alnofaiey YH, Binobaid FA, Jafarah LM, Khalil DA. Attitudes Towards Introduction of Multiple Modalities of Simulation in Objective Structured Clinical Examination (OSCE) of Emergency Medicine (EM) Final Board Examination: A Cross-Sectional Study. Open Access Emerg Med 2020; 12:441-449. [PMID: 33299360 PMCID: PMC7720994 DOI: 10.2147/oaem.s275764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/17/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose Objective Structured Clinical Examination (OSCE) is the current modality of choice for evaluating practical skills for graduating emergency medicine residents of final Saudi board examination. This study aims to evaluate the attitudes of both residents and faculty towards the idea of utilizing multiple modalities of simulation in a high-stakes emergency medicine (EM) examination. The goal is to propose a method to improve the process of this examination. Participants and Methods The data were obtained using a cross-sectional survey questionnaire that was distributed to 141 participants, including both EM residents and instructors in the Saudi Board of Emergency Medicine. An online survey tool was used. The data were collected and subsequently analyzed to gauge the general and specific attitudes of both residents and instructors. Results Of the 141 participants, 136 provided complete responses; almost half were residents from all years, and the other half were primarily instructors (registrars, senior registrars, or consultants). Most of the participants from both groups (70% of the residents and 86% of the instructors) would like to see simulation incorporated into the final EM board OSCEs. Most of the participants (78%), however, had no experience with using multiple modalities of simulation in OSCEs. Overall, the majority (74.82%) expressed the belief that simulation-based OSCEs would improve the assessment of EM residents’ competencies. The modalities that received the most support were part-task trainers and hybrid simulation (70.71% and 70%, respectively). Conclusion From this study, we can conclude that both parties (residents and instructors) are largely willing to see multimodality simulation being incorporated into the final board examinations. Stakeholders should interpret this consensus as an impetus to proceed with such an implementation of multimodality simulation. Input from both groups should be considered when planning for such a change in this high-stakes exam.
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Affiliation(s)
- Loui K Alsulimani
- Department of Emergency Medicine,Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Medical Education, King Abdulaziz University, Jeddah, Saudi Arabia.,Clinical Skills and Simulation Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fayhan M Al-Otaiby
- Department of Emergency Medicine, International Medical Center, Jeddah, Saudi Arabia
| | - Yasser H Alnofaiey
- Department of Emergency Medicine, Faculty of Medicine, Taif University, Taif, Saudi Arabia
| | - Fares A Binobaid
- Department of Emergency Medicine, King Abdulaziz Hospital, Makkah, Saudi Arabia
| | - Linda M Jafarah
- Department of Emergency Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Daniyah A Khalil
- Primary Healthcare Center, King Fahad General Hospital, Jeddah, Saudi Arabia
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