Benefits of targeted deployment of physician-led interprofessional pre-hospital teams on the care of critically Ill and injured patients: a systematic review and meta-analysis.
Matthew D Lavery, Arshbir Aulakh, Michael D Christian
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引用次数: 0
Abstract
Introduction: Over the past three decades, more advanced pre-hospital systems have increasingly integrated physicians into targeted roles, forming interprofessional teams. These teams focus on providing early senior decision-making and advanced interventions while also ensuring rapid transport to hospitals based on individual patient needs. This paper aims to evaluate the benefits of an inter-professional care model compared to a model where care is delivered solely by paramedics.
Methodology: A meta-analysis and systematic review were conducted using the guidelines of PRISMA 2020. Articles were identified through a systematic search of three databases and snowballing references. A systematic review was conducted of articles that met the inclusion criteria, and a suitable subset was included in a meta-analysis. The survival and mortality outcomes from the studies were then pooled using the statistical software Review Manager (RevMan) Version 8.2.0.
Results: Two thousand two hundred ninety-six articles were found from the online databases and 86 from other sources. However, only 23 articles met the inclusion criteria of our study. A pooled analysis of the outcomes reported in these studies indicated that the mortality risk was significantly reduced in patients who received pre-hospital care from interprofessional teams led by physicians compared with those who received care from paramedics alone (AOR 0.80; 95% CI [0.68, 0.91] p = 0.001). The survival rate of critically ill or injured patients who received pre-hospital care from interprofessional teams led by physicians was increased compared to those who received care from paramedics alone (AOR 1.49; 95% CI [1.31, 1.69] P < 0.00001).
Conclusions: The results of our analysis indicate that the targeted deployment of interprofessional teams led by physicians in the pre-hospital care of critically ill or injured patients improves patient outcomes.
在过去的三十年中，更先进的院前系统越来越多地将医生整合到目标角色中，形成跨专业团队。这些小组的重点是提供早期高层决策和先进干预措施，同时确保根据患者的个人需求迅速将其送往医院。本文的目的是评估一个跨专业的护理模式的好处相比，一个模式的护理是完全由护理人员提供。方法：采用PRISMA 2020指南进行荟萃分析和系统评价。通过对三个数据库和滚雪球式参考文献的系统搜索，确定了文章。对符合纳入标准的文章进行系统评价，并将合适的子集纳入meta分析。然后使用统计软件Review Manager (RevMan) Version 8.2.0汇总研究的生存和死亡率结果。结果：从网络数据库中检索到文献22996篇，从其他来源检索到文献86篇。然而，只有23篇文章符合我们的研究纳入标准。对这些研究报告的结果进行汇总分析表明，接受由医生领导的跨专业团队院前护理的患者的死亡风险明显低于仅接受护理人员护理的患者(AOR 0.80；95% CI [0.68, 0.91] p = 0.001)。接受由医生领导的跨专业团队院前护理的危重患者或受伤患者的生存率比仅接受护理人员护理的患者高(AOR 1.49；结论：我们的分析结果表明，在危重或受伤患者的院前护理中，有针对性地部署由医生领导的跨专业团队可以改善患者的预后。
期刊介绍：
The primary topics of interest in Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine (SJTREM) are the pre-hospital and early in-hospital diagnostic and therapeutic aspects of emergency medicine, trauma, and resuscitation. Contributions focusing on dispatch, major incidents, etiology, pathophysiology, rehabilitation, epidemiology, prevention, education, training, implementation, work environment, as well as ethical and socio-economic aspects may also be assessed for publication.
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