The impact of advanced practitioners on patients in acute care—A mini review

BackgroundAcute patient care is becoming increasingly complex due to various factors (e.g., demographic changes, multimorbidity, organizational changes). Educating healthcare professionals as advanced practitioners at Master's level is one response to these challenges. Meanwhile, there are several empirical insights into advanced roles.AimTo provide an overview on the impact of advanced practitioners on acute care patients' outcomes and safety.MethodsWe conducted a mini-review. Therefore, a systematic literature search was carried out in the four databases Medline, CINAHL, Cochrane Library, and PEDro. After four researchers screened the results and extracted the data independently, the included studies were analyzed thematically and clustered along patients' outcomes. The results are presented narratively.Results4,332 records were identified in the systematic search, and 67 articles were included in our review. Of these, the majority (n = 57) addressed the nursing profession. Advanced practitioners demonstrated an overall positive impact on acute care patients. They improved patients' vital signs, and reduced their mortality and adverse events (e.g., thrombosis, pneumonia, pressure injury). In addition, they shortened patients' length of stay and waiting times, and reduced admission rates. Patient satisfaction also increased after their implementation. When being compared to physicians, advanced practitioners in acute care demonstrated similar to equal patient outcomes and safety.ConclusionThe identified studies highlight the benefits of advanced practitioners for acute care patients. While most studies were conducted in emergency departments or intensive care units, further research concerning other acute settings (e.g., psychiatry) or clinical conditions (e.g., cognitive impairment) is recommended

Bildungsperspektive Notfallsanitäter:in:Interdisziplinärer Diskurs zu Ausbildung, beruflicher Praxis und Herausforderungen im Berufsfeld Rettungsdienst

Societal developments that result in an increase in geriatric, psychosocial, and subacute (i.e. not time-critical) emergencies are changing the demands on emergency care and posing challenges to the system of emergency care and emergency medical services (EMS). The training of emergency paramedics (NotSan) lays the foundation for finding a qualified systemic response to evolving patient needs and requirements. By extending and strengthening their competencies, NotSan are to be understood as basic emergency care providers. Their training should therefore be further developed in terms of evidence-based and patient-centered care in order to increase their competency to act and to achieve demand-oriented holistic (outpatient) care. New EMS resources such as community paramedics (GNFS) and telemedical support systems offer opportunities to strengthen competencies in patient care. The guiding principles of care should be patient safety and patient centeredness. In addition to increasing the basic competencies and equipment of existing EMS resources as well as continuous training opportunities, innovative cross-sectoral and cross-professional care concepts are necessary and must be supported

Patellar Tracking in Total Knee Arthroplasty—Influence on Clinical and Functional Outcome

Anterior knee pain is a common problem after primary total knee arthroplasty (TKA). The aim of this study was to find parameters in patellar positioning which influence the clinical and functional outcome after TKA. Included were 59 patients who underwent TKA, of which three patients were treated bilaterally (n = 62 included knees). In a periodical follow-up of up to 5 years, each patient had to answer three questionnaires (HSS, WOMAC, SF-36) and underwent three radiographies of the knee (including merchant view) and a clinical examination, including Range Of Motion (ROM). All radiographs were evaluated by a single observer blinded to clinical data, who collected multiple parameters of sagittal and axial patellar alignment including newly developed methods for measuring patellar shift and tilt. Depending on the measurement results, three groups were built for each parameter and the influence on the outcome was determined. A lateral patellar tilt of more than 4° resulted in lower scores for both the HSS and WOMAC. The rarely investigated patellar facet angle showed a significantly inferior clinical and functional outcome in late follow-up of >24 months if lower than 142°, possibly due to progressive osteosclerotic changes of the patella caused by increased contact stress with corresponding patellar morphology. No significant difference was found for all other parameters. The newly developed method for measuring patellar shift has proven to be a valuable and easy instrument in the postoperative setting

How Paramedics Experience the Decision to Continue or Terminate Out-of-Hospital Resuscitation: A Scoping Review Protocol

A scoping review aiming to summarise the present knowledge of paramedics' experiences regarding the decision to continue or terminate out-of-hospital resuscitation in the field

The Influence of Human Factors Training in Air Rescue Service on Patient Safety in Hospitals: Results of an Online Survey

Background: Air rescue crew members work equally in aviation and medicine, and thus occupy an important interface between the two work environments of aviation and medicine. The aim of this study was to obtain responses from participants to a validated online-based questionnaire regarding whether hospitals may benefit from the commitment of a medical hospital staff which is also professionally involved in the aviation system as emergency physicians and Helicopter Emergency Medical Services Technical Crew Members (HEMS TC). Furthermore, it focused on the question of whether the skills acquired through Crew Resource Management (CRM) training in the air rescue service might also be used in the ground-based rescue service and, if so, whether they may have a positive effect. Methods: Medical air rescue staff of 37 German air rescue stations was included. Between 27 November 2020 and 03 March 2021, 253 out of 621 employees (response rate: 40.7%) participated voluntarily in a validated anonymized online survey. A quantitative test procedure was performed using the modified questionnaire on teamwork and patient safety (German version). Results: The examination and interpretation of the internal consistency (Cronbach’s alpha) resulted in the following reliabilities: Factor I (Cooperation): α = 0.707 (good); Factor II (Human factors): α = 0.853 (very good); Factor III (Communication): α = 0.657 (acceptable); and Factor IV (Safety): α = 0.620 (acceptable). Factor analysis explained 53.1% of the variance. Conclusions: The medical clinicians participating in this online survey believed that the skills they learned in human factors training such as CRM are helpful in their daily routine work in hospitals or other medical facilities, as well as in their ground-based rescue service activities. These findings may result in the recommendation to make CRM available on a regular to the medical staff in all medical facilities and also to ground-based rescue service staff aiming to increase patient safety and employee satisfaction

Portal alumni

Begonnen hat es um 1900 mit Qualitätskontrolle, später folgte Qualitätsprüfung und seit Mitte der 90er Jahre hat das Thema Qualitätsmanagement Einzug gehalten in alle Bereiche von Politik und Gesellschaft. Im Gesundheitswesen, der Justiz und auch an vielen Hochschulen wurden spezielle Stellen eingerichtet, die sich gezielt mit der Umsetzung von Qualitätsentwicklung oder Qualitätsmanagement befassen. Das übergeordnete Ziel bei Einführung eines Qualitätsmanagements ist es, die Wettbewerbsfähigkeit der Organisation sowie auch die Zufriedenheit der Mitglieder der Institutionen und weiterer Stakeholder zu steigern, indem die Qualität der Tätigkeiten und der jeweiligen Rahmenbedingungen erhalten und optimiert wird. Mit der bewussten Entscheidung zur Qualitätssicherung und -entwicklung beginnt ein fortlaufender Prozess, der stetig intensiv begleitet werden muss. Qualitätsmanagement wirkt nachhaltig, in dem durch die Schaffung regelmäßiger und systematischer Strukturen und Prozesse auch zukünftig den beteiligten Personen ein optimales Handeln entsprechend der dann geltenden Bedingungen ermöglicht wird. Portal alumni widmet sich in seinem zehnten Heft diesem Thema und hat Absolventen der Universität Potsdam nach ihrem Tätigkeitsfeld im Qualitätsmanagement und den entsprechenden Erfolgen befragt. Dabei zeigt sich, dass Ehemalige Einsatzbereiche in Wirtschaft und Unternehmen aber auch in Sport, Bildung oder Hochschulen gefunden haben. Daneben berichten wir in diesem Heft von einem Projekt des Career Service, dem Schnupperjobben, und auch die Berichte über die Geschehnisse an Ihrer Alma mater kommen nicht zu kurz