Endovascular Treatment of Ischemic Stroke: Treat the right patient, at the right time, in the right place

The effect of endovascular treatment for ischemic stroke varies between individual patients and is highly time-dependent. The overall aim of this thesis was to increase the benefit of endovascular treatment by optimizing prediction of outcome and treatment effect (Part I), reducing treatment delay (Part II), and improving prehospital triage strategies (Part III)

The EMS Deficit: A Study on the Excessive Staffing Shortages of Paramedics and its Impact on EMS Performance in the States of South Carolina and North Carolina and Interventions for Organizational Improvements.

This is a qualitative multi-case study on emergency medical services (EMS) paramedic shortages, their effects on ambulance responses, and the quality of patient care in the prehospital environment. A qualitative multi-case study was selected for this study because the nature of the methods’ design aligned with a systematic approach of life experiences (Creswell, 2015). Paramedics who participated in this study provided insight, from life experiences, as to why one prematurely leaves EMS; thus, creating a staffing shortage. The foundation of this study is the high staffing shortages of paramedics specifically in South Carolina (SC) and North Carolina (NC). Drastically reducing paramedic attrition is critical in reducing patient suffering, decreasing morbidity and mortality, and improving EMS key performance indicators. The conceptual framework for this study aligns with Fredrick Herzberg’s Two-Factor Theory of Motivation and Abraham Maslow’s Hierarchy of Needs. In conclusion, the findings from this study have shown that the number of ambulances that are unstaffed from the paramedic shortage has reached critical levels. Primarily, this review of the literature’s discovered themes has identified numerous challenges contributing to the increasing EMS paramedic shortages and their effects on patient care in the pre-hospital environment. Secondarily, the interview portion of this study solidifies the discoveries of the cited works and identifies further challenges through its semi-structured interview format. Thirdly, achievable data from previous studies, primarily from the South Carolina EMS Association, validate this study’s findings through triangulation; thus, instilling rigor on primary reasons for EMS paramedic shortages and their impact on patient outcomes

How to Improve Assessment of Tetanus Immunity in the Emergency Room: A Prospective Cost-Effectiveness, Double Blind Study

peer reviewe

Still looking in the wrong place: literature-based evidence of why patients really attend an emergency department

Presenting complaints at an Emergency Department (ED) that could (and should) have been seen in primary care are discussed in the literature as ‘inappropriate use’ of hospital-based emergency services. These medically inappropriate requests are perceived as a threat to service quality, implying more costs than necessary. Using Systems Thinking/Dynamics, this paper introduces an evidence-based framework to explain why people increasingly attend an ED instead of a primary-care-based emergency facility, with patient demographics (age and deprivation), signposting sources and patients' perceptions (reflecting latent needs) identified as the main determinates of ED use. The framework makes explicit the endogenous dynamics of referral, service choice and service reputation (where expectations and confirming experiences are recursively shaped over time). The work can be employed at the strategic level as a framework to inform attendance management when evaluating or altering the healthcare system. This is achieved by presenting how the healthcare system responds to patient encounters and how patient behaviour adapts in response. At the operational level, the presented framework enables modellers and healthcare planners to develop hospital-based and primary-care-based emergency care interventions with empathy and compassion for patients. We highlight opportunities for future work as the healthcare system is complex and requires more in-depth exploration/modelling to complete the picture

Regulation 61-7 emergency medical services

This regulation defines various terms related to emergency medical services. It also outlines the requirements for licensure in emergency medical services. It states that only an entity can provide emergency medical response or ambulance services by obtaining a license and ambulance permit from the Department of Health and Environmental Control

Observational Data to Improve Clinical Decision Making in Acute Care

The premise of Big Data in acute medicine is to make medicine more efficient and effective. However, the translation of large observational data to knowledge is difficult. This thesis explores and discusses the three main types of research questions which can be asked from large observational data:1. What is current clinical practice?2. What is best practice?3. What patients need to be prioritised?This thesis will focus on traumatic brain injury and in-hospital cardiac arrest.<br/

Scope And Outcomes Of A Trauma Quality Improvement Program At Royal Prince Alfred Hospital, Australia 2006-2016

Background Injury and trauma remain important causes of morbidity and mortality globally. Trauma systems have been established to facilitate optimal management of injured patients, including timely access to specialist trauma centres in those who are severely injured. Trauma quality improvement programs have emerged over the past decade to evaluate and improve quality of care delivered by trauma systems and trauma centres. Despite this, there remains little evidence to demonstrate that these quality improvement programs actually improve patient outcomes or whether they are cost-effective. In 2006, a trauma quality improvement program was initiated at Royal Prince Alfred Hospital, Australia. This consisted primarily of the implementation of trauma team activation and resuscitation protocols, and the evaluation of care through the use of clinical indicators (key performance indicators) and measurement of post discharge health status. Objectives This thesis describes a quality improvement program at Royal Prince Alfred Hospital that involved monitoring of all major clinical services involved in the acute care of trauma at this hospital, and evaluates this program with respect to in-patient mortality for severe injury, cost effectiveness and long term outcomes. Methods The studies were conducted at Royal Prince Alfred Hospital (RPA) in New South Wales Australia. The thesis is presented in four main sections. The first section (chapters 1 to 4) provides an outline of the thesis and summarises the current literature on trauma quality improvement programs. Preliminary papers describe the historical context of the trauma service at this institution and discuss the conceptual framework for trauma patient data collection. The second section (chapters 5 to 9) provides background information regarding contemporaneous trends in injury presentations to Emergency Departments and major trauma activity and mortality across NSW. The third section (chapters 10 to 13) details and evaluates the impact of the trauma quality improvement program on long-term major trauma mortality trends at this hospital using time series analysis and its cost effectiveness in a subset of road trauma patients. It also investigates health status outcomes in trauma patients at three and six months after hospital discharge - a project initiated as part of the quality improvement program. Results Injury is one of the leading causes of presentations to Emergency Departments across NSW and the critically injured make up around 1% of total injury presentations. Major trauma in-hospital mortality across NSW has remained stable at around 16% between 2003 and 2014. The trauma quality improvement program at RPA was associated with a significant reduction in major trauma mortality from 16% to 10% after 2007. The incremental cost effectiveness was estimated to be $7600 per year of life saved in the subset of road trauma patients. Analyses of health outcomes after discharge revealed increasing injury severity and upper limb injuries were the only predictors of reduced employment status after injury, and lower limb injuries were associated with reduced physical health status compared to those without lower limb injuries at both 3 and 6 months post discharge. Around 37% of patients reported signs of psychological distress and this did not change significantly during the study interval. Conclusions This thesis has published important new information regarding the clinical and cost-effectiveness of trauma quality improvement programs. It contains the first published studies evaluating these interventions using formal time series and health economics analysis and one of few reporting the intervention in the context of existing injury and trauma management systems in New South Wales Australia