Establishing Core Elements for a Prehospital Emergency Care Systems Evaluation Tool (PECSET) for Systems in Early Stages of Development: A Delphi Consensus.

IF 2.1 3区 医学 Q2 EMERGENCY MEDICINE
Gayathri Devi Nadarajan, Pin Pin Pek, Audrey L Blewer, Ali Haedar, Catherine Staton, Kwanhathai Darin Wong, Faith Joan Mesa-Gaerlan, Sarah Karim, Sattha Riyapan, Truls Østbye, Marcus Eng Hock Ong, Anjni Joiner
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引用次数: 0

Abstract

Objectives: International Prehospital Emergency Care (PEC) standards have been primarily developed by and for high resource settings. Most PEC systems in Asia, which are still in the early stages of development, struggle to achieve these standards. There is a need for an evaluation tool which can define achievable basic building blocks for PEC systems in low resource settings to improve quality of PEC. We aimed to identify the core, basic elements (building blocks of a PEC system) for a Prehospital Emergency Care Systems Evaluation Tool (PECSET) for low resource settings in Asia.

Methods: A 4-stage modified Delphi consensus method was used to engage 32 PEC experts from 12 Asian countries. Participants voted on 32 elements identified from a prior scoping review, focus group discussions, and survey. Each round of voting was conducted through an anonymous, web-based application and followed by face-to-face group discussions. The first two rounds aimed to answer, "Is the element important and feasible in a low resource setting?" The last two stages aimed to answer "Should this element be prioritized as core in the tool?" A thematic analysis of the recorded and transcribed discussions was used to identify participants' rationale for prioritization.

Results: After four rounds of voting, 12 elements were identified as core elements: (1) dispatch assisted instructions, (2) protocols for screening, triage and destination, (3) medical direction, (4) standardized training programs, (5) minimum ambulance standards, (6) operational metrics, (7) quality assurance, (8) operational safety protools, (9) essential patient care documentation, (10) medical records management, (11) layperson awareness and education and (12) universal access emergency number. However, the participants decided to include all 32 elements in the tool grouped into broader categories by percent agreement for a tiered approach for early, intermediate, and advanced PEC systems. Rationales for prioritization included a need for focus on basic infrastructure and building resilience in resource-stretched systems.

Conclusions: Through a Delphi consensus process, stakeholders identified core elements for PEC systems in low resource settings. These findings will inform the development of a tool for quality assurance and monitoring in low resource settings in South and Southeast Asian countries.

为早期发展阶段的系统建立院前急救系统评估工具(PECSET)的核心要素:德尔菲共识。
目的:国际院前急救(PEC)标准主要是由高资源环境制定的。亚洲大多数PEC系统仍处于发展的早期阶段,难以达到这些标准。需要一种评估工具,它可以定义低资源环境下PEC系统可实现的基本构建模块,以提高PEC的质量。我们旨在为亚洲低资源环境下的院前急救系统评估工具(PECSET)确定核心、基本要素(PEC系统的构建模块)。方法:采用四阶段修正德尔菲共识法对来自12个亚洲国家的32位PEC专家进行调查。与会者对从先前的范围审查、焦点小组讨论和调查中确定的32个要素进行了投票。每一轮投票都是通过匿名的网络应用程序进行的,然后是面对面的小组讨论。前两轮旨在回答:“在资源匮乏的环境中,元素是否重要且可行?”最后两个阶段的目的是回答“这个元素应该作为工具的核心优先考虑吗?”对记录和转录的讨论进行专题分析,以确定与会者确定优先次序的理由。结果:经过四轮投票,12个要素被确定为核心要素:1)调度辅助指令,2)筛查、分诊和目的地协议,(3)医疗指导,4)标准化培训计划,5)最低救护车标准,6)操作指标,7)质量保证,8)操作安全工具,9)基本患者护理文件,10)医疗记录管理,11)外行人意识和教育,12)普遍接入紧急号码。然而,参与者决定将工具中的所有32个元素按百分比划分为更广泛的类别,以用于早期,中级和高级PEC系统的分层方法。确定优先次序的理由包括需要把重点放在基本基础设施和在资源紧张的系统中建立复原力。结论:通过德尔菲共识过程,利益相关者确定了低资源环境下PEC系统的核心要素。这些发现将为南亚和东南亚国家资源匮乏环境下质量保证和监测工具的开发提供信息。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Prehospital Emergency Care
Prehospital Emergency Care 医学-公共卫生、环境卫生与职业卫生
CiteScore
4.30
自引率
12.50%
发文量
137
审稿时长
1 months
期刊介绍: Prehospital Emergency Care publishes peer-reviewed information relevant to the practice, educational advancement, and investigation of prehospital emergency care, including the following types of articles: Special Contributions - Original Articles - Education and Practice - Preliminary Reports - Case Conferences - Position Papers - Collective Reviews - Editorials - Letters to the Editor - Media Reviews.
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