Failure to recognize and respond to changes in a patient’s condition is a limitation in the effective utilization of Medical Emergency Teams (METs). A system that uses smartphone technology to facilitate vital signs collection at bedside has been developed. The alerts engine, based upon Mount Sinai Hospital’s (MSH) MET calling criteria, can automatically alert the MET of patients exhibiting abnormal vital signs. The system, without automated alerting, was piloted at MSH. Sensitivity and specificity calculations revealed that the MSH algorithm had a lower sensitivity and specificity than the Cuthbertson or the Modified Early Warning Score algorithms. This suggests that the MSH algorithm, compared to the others, was poor at identifying patients that did and did not require a MET consultation. Furthermore, the low positive predictive value suggests that the majority of alerts were not associated with a MET call. Therefore, the MSH algorithm is not recommended for the automated system.

Failure to recognize and respond to changes in a patient’s condition is a limitation in the effective utilization of Medical Emergency Teams (METs). A system that uses smartphone technology to facilitate vital signs collection at bedside has been developed. The alerts engine, based upon Mount Sinai Hospital’s (MSH) MET calling criteria, can automatically alert the MET of patients exhibiting abnormal vital signs. The system, without automated alerting, was piloted at MSH. Sensitivity and specificity calculations revealed that the MSH algorithm had a lower sensitivity and specificity than the Cuthbertson or the Modified Early Warning Score algorithms. This suggests that the MSH algorithm, compared to the others, was poor at identifying patients that did and did not require a MET consultation. Furthermore, the low positive predictive value suggests that the majority of alerts were not associated with a MET call. Therefore, the MSH algorithm is not recommended for the automated system.

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Titel: Sjuksköterskors upplevelse av att arbeta med hastigt försämrade patienter efter genomförd ALERT-utbildning Bakgrund: Patienter som fått hjärt- och/eller andningsstillestånd på vårdavdelningar och som läggs in på intensivvårdsavdelning (IVA) har haft försämrade vitalparametrar redan 6-8 timmar innan ankomst till IVA. 50 % av dessa inläggningar hade kunnat förhindras om personalen på avdelningen haft rätt kunskap i att upptäcka varningssignaler och hur de åtgärdas. ALERT-utbildningen uppmuntrar till användandet av ett enkelt verktyg för bedömningen av patienter, vilket leder till ökat självförtroende och minskad ångest i hanteringen av akut sjuka patienter och intensivvård kan undvikas eller sättas in i rätt tid. Syfte: Att undersöka sjuksköterskors upplevelse av att arbeta med hastigt försämrade patienter efter genomförd ALERT-utbildning Metod: Intervjuer med tolv allmänsjuksköterskor på kirurgisk och medicinsk vårdavdelning. Insamlad data analyserades med kvalitativ innehållsanalys. Resultat: Vid analys av texten framkom totalt tre övergripande teman; Ökad förmåga till tidigare varseblivning, Känsla av ökad trygghet i sjuksköterskerollen och Upplevelse av ökad patientsäkerhet. Dessa teman mynnade ut i sex subteman; Tidiga varningssignaler uppmärksammas, Kontroller samt åtgärd vid hastig försämring, Ökat självförtroende, Viktigt med repetition, Struktur ger säkerhet i arbetet samt Sjuksköterskornas stöd för att bedöma olika vitalparametrar. Slutsats: Sjuksköterskorna upplever att ALERT-utbildningen ökar deras självförtroende och höjer patientsäkerheten, samt att regelbundna repetitioner är viktigt för att upprätthålla kunskapen.

Sammanfattning Bakgrund: Intensivvårdssjuksköterskan ingår tillsammans med en narkosläkare i en Mobil Intensivvårdsgrupp (MIG). Om en patient på en vårdavdelning påvisar försämring i vitala parametrar och misstänks ha en begynnande organsvikt konsulteras MIG som tillsammans med patientansvarig läkare och sjuksköterska utvärderar och bedömer patienten. MIG rekommenderar därefter en behandling eller flyttar patienten till intensivvårdsavdelning. Syfte: Syftet med studien var att beskriva intensivvårdssjuksköterskors upplevelser av att bedöma patienter i samband med MIG-uppdrag samt vad de beaktar i samband med bedömningen. Metod: Studien genomfördes med en kvalitativ ansats och beskrivande design. Elva intensivvårdssjuksköterskor intervjuades med hjälp av semistrukturerade intervjuer. Resultat: Det framkom sex huvudkategorier i resultatet: Att vara förberedd och ha information har betydelse för bedömning, Att använda sina sinnen och erfarenhet vid bedömning, Att samarbeta med andra personalkategorier har betydelse, Att använda hjälpmedel vid bedömning, Att ha upplevelser av miljön kring patienten i samband med bedömning, och Att begränsningar inverkar vid bedömning och fortsatt vård. Intensivvårdssjuksköterskorna beskrev att strukturerad rapport, bra samarbete samt att använda hjälpmedel, klinisk blick och erfarenhet underlättade vid bedömningen. Resultatet visade även att det tycktes finnas individuella skillnader i hur bedömningen utfördes och på vilka grunder besluten togs samt att hög belastning, stress, resursbrist, vårdbegränsningar och distraktion i omkringliggande miljö kunde ha inverkan på bedömning. Slutsats: Studiens resultat har bidragit till att öka förståelsen av intensivvårdssjuksköterskornas upplevelser vid bedömning av patienter i samband med MIG-uppdrag. Studiens resultat har också uppmärksammat att hög arbetsbelastning, stress, miljö, vårdbegränsningar och personalbrist kan ha inverkan vid bedömning av patienter. Nyckelord: Intensivvårdssjuksköterska, Mobil intensivvårdsgrupp, Vårdbehovsbedömning / Abstract Background: The intensive care nurse, together with an anesthetist, is included in a Medical emergency team (MET). If a patient in a ward demonstrates deterioration in vital parameters and is suspected having organ failure, MET is consulted, which together with the patient-responsible doctor and nurse evaluates and assesses the patient. Thereafter MET recommends treatment or move the patient to intensive care unit. Aim: The aim of this study was to describe intensive care nurses experiences of assessing patients and what they consider in connection with the MET assessments. Method: The study was performed with a qualitative approach and descriptive design. Eleven intensive care nurses were interviewed with semi-structured interviews. Result: Six main categories appeared in the result: To be prepared and have information is important for assessment, To use senses and experience when assessing, To cooperate with other staff categories is important, To use assessment tools, To have experiences of the environment around the patient in connection with the assessment, and that limitations affect the assessment and further care. The intensive care nurses described that structured patient-information, good teamwork, using assessment tools, clinical judgement and experience made the assessment easier. The result also showed that there appeared to be individual differences in how the assessment was carried out and on what grounds the decisions were taken. High workload, stress, lack of resource, limitations in care and distraction in the environment could have an impact on assessment. Conclusion: The results have contributed to increasing the understanding of the intensive care nurses experiences of assessing patients in connection with MET assignments. The results have also drawn attention to the fact that high workload, stress, environment, limitations in care and lack of resource can have an impact on patient assessment. Key words: Intensive care nurse, Medical emergency team, Nursing assessment

Prevention of in-hospital cardiac arrest (IHCA) is critical to reducing morbidity and mortality as both the rates of return to pre-hospital functional status and overall survival after IHCAs are low. Early identification of patients at risk and prompt clinical intervention are vital patient safety strategies to reduce IHCA. One widespread strategy is the Rapid Response System (RRS), which incorporates early risk identification, expert consultation, and key clinical interventions to bedside nurses caring for patients in clinical deterioration. However, evidence of RRS effectiveness has been equivocal in the patient safety literature. This study utilized a holistic Realistic Evaluation (RE) framework to identify important clinical environment (context) and system triggers (mechanisms) to refine our understanding of an RRS to improve local patient emoutcomesem and develop a foundation for building the next level of evidence within RE research. The specific aims of the study are to describe a RRS through context, mechanism, and outcome variables; explore differences in RRS outcomes between medical and surgical settings, and identify relationships between RRS context and mechanism variables for patient outcomes. Study RRS data was collected retrospectively from a 397-bed community hospital in the Midwest; including all adult inpatient RRS events from May 2006 (2 weeks post-RRS implementation) through November 2013. RRS events were analyzed through descriptive, comparative, and proportional odds (ordinal) logistic regression analyses. The study found the majority of adult inpatient RRS events occurred in medical settings and most were activated by staff nurses. Significant differences were noted between RRS events in medical and surgical settings; including patient status changes in the preceding 12 hours, event trigger patterns, and immediate clinical outcomes. Finally, proportional odds logistic regression revealed significant relationships between context and mechanism factors with changes in the risk of increased clinical severity immediately following at RRS event. RE was utilized to structure a preliminary study to explore the complex variables and relationships surrounding RRSs and patient outcomes. Further exploration of settings, changes in clinical status, staffing and resource access, and the ways nurses use RRSs is necessary to promote the early identification of vulnerable patients and strengthen hospital patient safety strategies.

The purpose of the present study were to (a) explore the relationship between the frequency of use of Rapid Response Teams (RRTs) by hospital staff nurses and the support received from RRTs; (b) to investigate staff nurses’ perceptions of their individual level, group level and organizational level learning as a result of single or multiple exposures to the RRT; (c) to identify predictors of learning outcomes and (d) to identify overall impressions and advantages and disadvantages of the RRT. A mail survey was used to collect data. The response responses rate was 33%, 131 registered nurses responded to the survey (pre-test = 12, study = 119). The results of Pearson r correlation suggest that a high frequency of access of RRTs was positively related to process support (r = .25, p < .01). Also, perceived content and process support from RRTs was positively related to maintenance and building of staff nurses’ mental models regarding patient deterioration pertaining to self, group and organization. Multiple regression analyses show that sociodemographic and independent variables predict organizational learning outcomes (mental model maintenance and building). Overall impressions of the RRTs were high. A content analysis of nurses’ comments indicated that there were more advantages to having the RRTs than disadvantages. This study suggests that RRTs are influential in changing nurses’ perceptions about managing patient deterioration. Training programs for RRTs should include both content and process support, which may enhance building and maintaining mental models. / Thesis (Master, Nursing) -- Queen's University, 2008-09-25 21:27:44.682

Orientador: Eduardo Daruge Junior / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-13T01:19:57Z (GMT). No. of bitstreams: 1 Caputo_IsamaraGeandraCavalcanti_M.pdf: 1294241 bytes, checksum: 2d36f854727c093fdc1742419a0a20a7 (MD5) Previous issue date: 2009 / Resumo: A Odontologia como profissão da área da saúde, têm mostrado uma enorme evolução em seus procedimentos, materiais e técnicas a fim de promover a reabilitação do complexo maxilo-mandibular. Independente de sua evolução, e infinitos horizontes que pode alcançar, ela não está livre de riscos que podem acontecer no seu dia-dia. O Cirurgião-Dentista (CD), em seu cotidiano laborativo está intimamente ligado com o risco de ocorrer em seu consultório uma emergência médica. Mesmo não sendo comuns, essas emergências podem acontecer em ambiente odontológico. Podem acometer qualquer indivíduo, antes, durante ou após a intervenção odontológica. Desta maneira além dos acometimentos relativos à saúde de seus pacientes o CD também está às vistas com as implicações legais que estas emergências geram para o profissional. Neste contexto, o CD tem que se ater a toda responsabilidade que tem para com o paciente, no sentido promoção de saúde, e no sentido legal. O CD deve estar preparado para todos os eventos que possam a vir a acontecer em seu ambiente de trabalho. Uma avaliação do estado geral de saúde de seus pacientes, adoção de medidas preventivas e jurídicas, dá maior segurança no atendimento. Em vista destes fatos, o presente estudo visou obter dados sobre as ocorrências de emergências médicas nos consultórios odontológicos na cidade de Ribeirão Preto - SP, se os CDs estão preparados para este tipo de atendimento, bem como, se conhecem as implicações éticas e legais as quais estão submetidos, além de oferecer aos profissionais uma orientação legal para esses possíveis acontecimentos, elucidando as implicações éticas e legais as quais estão impostos / Abstract: The Odontology as health profession has shown an enormous development in yours, and its procedures, materials and techniques in order to promote the rehabilitation of complex maxillo madibular. Independently of its development, and infinite horizons that can be achieved, it is not free of risk which may occur in their day-day. The Surgeon-Dentist, in their day work is closely linked with the risk of occur in your office A medical emergency. Even not being common, such emergencies may occur in the dental office. May tackle any individual, before, during or after the dentistry intervention. In this way higher than the events allied to the health of their patients the dentist is also engaged with the legal implications that these emergencies generate to professional. In this context, the dentist has to know to the entire responsibility for the patient, to health promotion, and in the sense legally. The dentist must be prepared for all the events that can happen in their workplace. An assessment of the general state of health of their patients, the adoption of the preventive and legal measures, gives greater security in service. In view of those facts, this study aimed at obtaining the occurrence of medical emergencies in the dental office in the city of Ribeirao Preto - SP, if the dentists are prepared for this type of care, as well as, if you know the ethical and legal implications which are submitted, in addition to offer professional legal guidance for such possible events, elucidating the ethical and legal implications which are subordinates / Mestrado / Odontologia Legal e Deontologia / Mestre em Biologia Buco-Dental

This dissertation is a conversation analytic examination of recurrent practices of interaction in medicalemergency calls. The study expands the analytical focus in past research on emergency calls betweenemergency call operators and callers to pre-hospital emergency care interaction on the phone betweennurses, physicians and callers. The investigation is based on ethnographic fieldwork in a Swedish emergencycontrol centre. The data used for the study consists primarily of audio recordings of medical emergency calls.Fundamental procedures in medical emergency calls examined in the dissertation are: (1) questioning; (2)emotion management; (3) risk management and (4) instruction giving. Emergency call-takers ask questions toelicit descriptions by callers of what is happening and to manage symptoms of patients to help keep them safeuntil ambulance crews arrive. In the questioning practice about acutely ill or injured patients call-takers usemainly yes-no questions and clarify problems by questioning callers making a distinction between defined andundefined problems. The analysis reveals four core types of emotion management practices: (1) call-takerskeep themselves calm when managing callers’ social displays of emotions; (2) promising ambulanceassistance; (3) providing problem solving presentations including emergency response measures to concernsof callers, and (4) emphasising the positive to create hope for callers. Call-takers use seven key procedures tomanage risk in medical emergency calls: (1) risk listening through active listening after actual and possiblerisks; (2) risk questioning; (3) risk identification; (4) risk monitoring; (5) risk assessment; (6) making decisionsabout elicited risk and (7) risk reduction. Instruction giving using directives and recommendations isaccomplished by call-takers in four main ways: (1) acute flow maintaining instruction giving when callers areprocedurally out of line; (2) measure oriented instructions for patient care and emergency responsemanagement; (3) organisational response instructions and (4) summarising instruction giving. Callers routinelyacknowledge risk identifications and follow instructions delivered by call-takers to examine statuses and lifesigns of patients such as breathing, movement and pulse, and perform basic first aid and emergency responsemeasures.The findings generated from this study will be useful in emergency call-taker training in carrying out interactiveprocedures in medical emergency calls and add to the larger research programmes on on-telephoneinteraction between professionals and citizen callers. This is an essential book for pre-hospital emergency careproviders and institutional interaction researchers and students. / <p>At the Faculty of Social Sciences in the subject of Sociology</p>

Os sistemas de Informações Geográficas foram desenvolvidos com os avanços das Ciências da Computação, com base nos conceitos das Ciências Geodésicas, para serem aplicados em áreas onde os dados espaciais são utilizados. Procura-se obter uma otimização desta tecnologia, possibilitando o desenvolvimento de sistemas aplicativos interativos. Abordam-se conceitos relativos a modelagem de dados espaciais. Analisam-se a aplicação no mundo real e no modelo conceitual decorrentes. Formula-se um modelo físico com base na Emergência Médica, obtendo-se um sistema que integra programas de saúde para localização de pacientes. / The Geographic Information Systems has been developed based on the progress of the computer sciences, using concepts of the geodesic sciences, to by applied where spatial data are need. This technology is optimized and interactive systems are made. Concepts relative to spatial data modeling are discussed. The application on the real world and the conceptual model is analyzed. The physical model is formulated based on the medical emergency, to obtain a system that integrates health programs to find patients.