背景:急诊医疗服务(EMS)提供者和急诊科(ED)护士之间的护理过渡对于患者护理和安全至关重要。然而,EMS提供者和ED护士之间的互动可能存在沟通差距,尚未得到广泛研究.这篇综述的目的是研究(1)影响从EMS提供者到ED护士的护理过渡的因素,以及(2)改善这些过渡的干预策略的有效性。方法:我们进行了一项混合方法的系统评价,包括电子数据库的搜索(DARE,MEDLINE,EMBASE,Cochrane中央控制试验登记册,CINAHL,乔安娜·布里格斯研究所EBP),灰色文献数据库,组织网站,询问急诊医学专家,以及纳入研究中引用的参考文献清单。任何设计的所有英语语言研究都有资格纳入。两名审稿人独立筛选标题/摘要和全文的包容性和方法学质量,以及从纳入研究中提取的数据。我们使用叙事和主题综合来整合和探索数据中的关系。结果:总的来说,筛选了8,348项研究,并选择了130项进行全文审查。最终的合成包括20项研究。在15项中等至高方法学质量的研究中,影响过渡的6个因素:不同的专业镜头,操作限制,专业关系,专业之间共享的信息,过渡过程的组成部分,以及患者的表现和参与。在6项方法学薄弱的研究中确定了三种干预措施:(1)过渡指南(DeMIST,Identification,机制/医疗投诉,与投诉有关的伤害/信息,迹象,治疗和趋势-过敏,药物治疗,背景历史,其他信息[IMIST-AMBO])通过培训,(2)基于移动Web的技术(EMS智能手机和地理信息系统位置数据),和(3)新的临床角色(ED救护车卸载护士致力于分类和评估EMS患者)。对于过渡指南的有效性和新的临床作用,有不同的发现。EMS提供商和ED护士都积极地认为移动技术有助于更好地描述院前环境和ED中的计划流程。结论:虽然多媒体应用可能会改善切换过程,未来的干预研究需要严格设计。我们建议对EMS和ED员工进行跨学科培训,以使用灵活的结构化协议,特别是考虑到审查发现,跨学科的沟通和关系可能是具有挑战性的。
Background: Transitions in care between emergency medical services (EMS) providers and emergency department (ED) nurses are critical to patient care and safety. However, interactions between EMS providers and ED nurses can be problematic with communication gaps and have not been extensively studied. The aim of this
review was to examine (1) factors that influence transitions in care from EMS providers to ED nurses and (2) the effectiveness of interventional strategies to improve these transitions. Methods: We conducted a mixed-methods systematic
review that included searches of electronic databases (DARE, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Joanna Briggs Institute EBP), gray literature databases, organization websites, querying experts in emergency medicine, and the reference lists cited in included studies. All English-language studies of any design were eligible for inclusion. Two reviewers independently screened titles/abstracts and full-texts for inclusion and methodological quality, as well as extracted data from included studies. We used narrative and thematic synthesis to integrate and explore relationships within the data. Results: In total, 8,348 studies were screened and 130 selected for full text
review. The final synthesis included 20 studies. Across 15 studies of moderate-to-high methodological quality, 6 factors influenced transitions: different professional lenses, operational constraints, professional relationships, information shared between the professions, components of the transition process, and patient presentation and involvement. Three interventions were identified in 6 methodologically weak studies: (1) transition guideline (DeMIST, Identification, Mechanism/Medical complaint, Injuries/Information related to the complaint, Signs, Treatment and Trends - Allergies, Medication, Background history, Other information [IMIST-AMBO]) with training, (2) mobile web-based technology (EMS smartphone and geographic information system location data), and (3) a new clinical role (ED ambulance off-load nurse dedicated to triaging and assessing EMS patients). There were mixed findings for the effectiveness of transition guidelines and the new clinical role. Mobile technology was seen positively by both EMS providers and ED nurses as helpful for better describing the pre-hospital context and for planning flow in the ED. Conclusion: While multimedia applications may potentially improve the handoff process, future intervention studies need to be rigorously designed. We recommend interdisciplinary training of EMS and ED staff in the use of flexible structured protocols, especially given
review findings that interdisciplinary communication and relationships can be challenging.