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Hagel S, Liedtke KR, Bax S, Wailke S, Klüter T, Behrendt P, Franke GM, Seekamp A, Langguth P, Balandin A, Grünewald M, Schunk D. [Patient safety in differentiated (in-hospital) activation of the resuscitation room for severely injured patients]. Unfallchirurgie (Heidelb) 2023; 126:441-448. [PMID: 36622382 PMCID: PMC9827437 DOI: 10.1007/s00113-022-01279-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND OBJECTIVE Providing trauma services demands high personnel resources and structural costs. The goal of this study was to show if the assignment of trauma patients to a defined A or B resuscitation room treatment as a modified management concept is safe and feasible. MATERIAL AND METHODS Between May 2020 and January 2021, all resuscitation room trauma patients were included in this single center prospective observational study. All patients admitted to the resuscitation room underwent a classification according to the German S3 guidelines grade of recommendation GoR A and GoR B in polytrauma and the status of the ABCDE sequence to an A and B resuscitation room. The classification was performed by the senior consultant on call via telephone after consultation and discussion of clinical findings. RESULTS All 135 resuscitation room patients were included in the study of whom 42 trauma patients were assigned to the A resuscitation room (A-SR) and 93 were assigned to the B resuscitation room (B-SR). The comparison of the two groups showed that patients in the A‑SR group are more likely to be accompanied by a prehospital emergency physician (80.5%) than patients in the B‑SR group (55.5%). Patients in the B‑SR group showed a significantly higher Glasgow coma scale (GCS). Using the eFAST emergency ultrasound protocol, 2.4% of the A‑SR and 4.3% of the B‑SR patients had trauma-associated pathologies, 26% of the A‑SR and only 3.2% of the B‑SR patients had to be admitted to the ICU, 21.4% of the A‑SR and 1% of the B‑SR patients died within 30 days after trauma. The injury severity scores (ISS) of the A‑SR patients were significantly higher than in the B‑SR group (ISS 28.3 vs. 6.8). CONCLUSION The study confirmed that the assignment by the emergency department consultant according to the German S3 guideline in combination with the ABCDE sequence into resuscitation room A or B treatment is feasible, does not compromise the quality of care and is efficient in the use of the personnel resources.
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Affiliation(s)
- S Hagel
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - K R Liedtke
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - S Bax
- Zentrale Einrichtung Interdisziplinäre Notaufnahme, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - S Wailke
- Zentrale Einrichtung Interdisziplinäre Notaufnahme, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - T Klüter
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - P Behrendt
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - G M Franke
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A Seekamp
- Klinik für Unfallchirurgie und Orthopädie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - P Langguth
- Klinik für Radiologie und Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - A Balandin
- Klinik für Anästhesiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - M Grünewald
- Klinik für Anästhesiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - D Schunk
- Zentrale Einrichtung Interdisziplinäre Notaufnahme, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
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Lavoie B, Bourque CJ, Côté AJ, Rajagopal M, Clerc P, Bourdeau V, Ali S, Doyon-Trottier E, Castonguay V, Fontaine-Pagé É, Burstein B, Desaulniers P, Goldman RD, Thompson G, Berthelot S, Lagacé M, Gaucher N. The responsibility to care: lessons learned from emergency department workers' perspectives during the first wave of the COVID-19 pandemic in Canada. CAN J EMERG MED 2022; 24:482-492. [PMID: 35543924 PMCID: PMC9091548 DOI: 10.1007/s43678-022-00306-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/24/2022] [Indexed: 11/24/2022]
Abstract
Background This study’s objective was to examine emergency department (ED) workers’ perspectives during the Canadian COVID-19 first wave. Methods This qualitative study included workers from nine Canadian EDs who participated in 3 monthly video focus groups between April and July 2020 to explore (1) personal/professional experiences, (2) patient care and ED work, (3) relationships with teams, institutions and governing bodies. Framework analysis informed data collection and analysis. Results Thirty-six focus groups and 15 interviews were conducted with 53 participants (including 24 physicians, 16 nurses). Median age was 37.5 years, 51% were female, 79% had more than 5 years’ experience. Three main themes emerged. (1) Early in this pandemic, participants felt a responsibility to provide care to patients and solidarity toward their ED colleagues and team, while balancing many risks with their personal protection. (2) ED teams wanted to be engaged in decision-making, based on the best available scientific knowledge. Institutional decisions and clinical guidelines needed to be adapted to the specificity of each ED environment. (3) Working during the pandemic created new sources of moral distress and fatigue, including difficult clinical practices, distance with patients and families, frequent changes in information and added sources of fatigue. Although participants quickly adapted to a “new normal”, they were concerned about long-term burnout. Participants who experienced high numbers of patient deaths felt especially unprepared. Interpretation ED workers believe they have a responsibility to provide care through a pandemic. Trust in leadership is supported by managers who are present and responsive, transparent in their communication, and involve ED staff in the development and practice of policies and procedures. Such practices will help protect from burnout and ensure the workforce’s long-term sustainability. Supplementary Information The online version contains supplementary material available at 10.1007/s43678-022-00306-z.
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Affiliation(s)
- Bertrand Lavoie
- Faculty of Law, Université Sherbrooke, CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Claude Julie Bourque
- CHU Sainte-Justine Research Centre and Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Anne-Josée Côté
- Department of Pediatric Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Manasi Rajagopal
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Paul Clerc
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Valérie Bourdeau
- Centre d'excellence en Éthique Et Partenariat, CHU Sainte-Justine, Montreal, QC, Canada
| | - Samina Ali
- Departments of Pediatrics and Emergency Medicine, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada
| | - Evelyne Doyon-Trottier
- Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Véronique Castonguay
- Department of Family and Emergency Medicine, Sacré Coeur Hospital, Université de Montréal, Montreal, QC, Canada
| | - Érika Fontaine-Pagé
- Verdun Hospital, CIUSSS Centre-Sud-de-L'Île-de-Montréal, Montreal, QC, Canada
| | - Brett Burstein
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada.,Department of Epidemiology, Biostatics and Occupational Health, McGill University, Montreal, QC, Canada
| | - Pierre Desaulniers
- Department of Family and Emergency Medicine, Centre Hospitalier de L'Université de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Ran D Goldman
- The Pediatric Research in Emergency Therapeutics Program, Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Graham Thompson
- Departments of Pediatrics and Emergency Medicine, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Simon Berthelot
- CHU de Québec-Université Laval, Département de Médecine Familiale Et de Médecine d'urgence, Université Laval, Quebec City, QC, Canada
| | - Maryse Lagacé
- CHU Sainte-Justine Research Centre, Montreal, QC, Canada
| | - Nathalie Gaucher
- CHU Sainte-Justine Research Centre and Pediatric Emergency Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada.
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