Emergency Medical Services (EMS) Clinician Perspectives on the Pediatric Observation Priority Score (POPS).

IF 2.1 3区 医学 Q2 EMERGENCY MEDICINE
Caleb E Ward, Daniel X Zhang, Judith Singletary, Damian Roland, James M Chamberlain
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引用次数: 0

Abstract

Objectives: Approximately 50% of children assessed by emergency medical services (EMS) in the United States (U.S.) have no emergent needs. The lack of validated triage tools to identify children at low risk of deterioration without transport is one reason that children have not been included in most alternative disposition programs. The Pediatric Observation Priority Score (POPS) is a triage tool incorporating vital signs and clinical observations. British prehospital studies show the POPS accurately identifies low-acuity children. The POPS has not been assessed in the U.S. Our objective was to determine whether U.S. EMS clinicians find the POPS acceptable, appropriate, and feasible.

Methods: We conducted a mixed methods study with EMS clinicians. Participants were provided with an overview of the POPS then completed a survey using the validated Acceptability, Appropriateness, and Feasibility of Implementation Measures (12 Likert-scale questions [1 = strongly disagree to 5 = strongly agree]). We calculated mean question scores. A PhD-trained facilitator conducted cognitive interviews with a subset of participants to explore their perception of the POPS. Multiple investigators coded transcripts until we reached thematic saturation.

Results: We recruited 100 participants (51% paramedics, 48% emergency medical technician (EMTs)) with a median (IQR) of 5 years (3, 9) clinical experience. Individual question mean scores across all domains ranged from 4.4-4.6. Paramedic and EMT responses were similar. 10 participants completed interviews and agreed the POPS was acceptable, appropriate, and feasible. Positive themes from analysis included: (1) ease of use and (2) helpful additional tool. Facilitators to implementation included (1) embedding the POPS in documentation systems (2) with a force function, (3) positive messaging, and (4) incorporating the POPS in protocols. Implementation barriers included (1) resistance to mandatory documentation, (2) undermining professional standing, (3) impaired rapport with patients, (4) uncertainty about integration with protocols, (5) and concern about legal liability. Participants suggested changes in wording and question order to improve usability.

Conclusions: Prehospital clinicians in the U.S. find the POPS acceptable, appropriate, and feasible for implementation with minor modifications. Further research is needed to determine whether EMS clinicians can accurately apply the POPS in controlled and field settings before implementation.

急诊医疗服务(EMS)临床医生对儿科观察优先评分(POPS)的看法。
目标:美国紧急医疗服务(EMS)评估的儿童中约有50%没有紧急需求。缺乏有效的分类工具来识别儿童在没有运输的情况下病情恶化的风险较低,这是儿童没有被纳入大多数替代处置方案的原因之一。儿科观察优先评分(POPS)是一种结合生命体征和临床观察的分诊工具。英国院前研究表明,持久性有机污染物能准确识别低视力儿童。美国尚未对持久性有机污染物进行评估。我们的目的是确定美国EMS临床医生是否认为持久性有机污染物是可接受的、适当的和可行的。方法:我们与EMS临床医生进行了一项混合方法研究。研究人员向参与者提供持久性有机污染物的概述,然后使用经过验证的实施措施的可接受性、适当性和可行性完成一项调查(12个李克特量表问题[1 =非常不同意到5 =非常同意])。我们计算平均分。一名受过博士培训的主持人与一部分参与者进行了认知访谈,以探讨他们对持久性有机污染物的看法。多名调查员对记录进行编码直到主题饱和。结果:我们招募了100名参与者(51%的护理人员,48%的紧急医疗技术员(EMTs)),中位(IQR)为5年(3,9)临床经验。每个问题在所有领域的平均得分在4.4 - 4.6之间。护理人员和急救人员的反应相似。10名与会者完成访谈,并同意持久性有机污染物是可接受的、适当的和可行的。分析得出的积极主题包括:1)易用性和2)有用的附加工具。促进实现的因素包括:1)在文档系统中嵌入持久性有机污染物;2)具有强制功能;3)积极的消息传递;4)将持久性有机污染物纳入协议。实施障碍包括:1)抗拒强制性文件;2)损害专业地位;3)与患者的关系受损;4)不确定是否符合协议;5)担心法律责任。与会者建议修改措辞和问题顺序,以提高可用性。结论:美国院前临床医生发现持久性有机污染物是可接受的、适当的、可行的,只需稍加修改即可实施。需要进一步的研究来确定EMS临床医生是否能够在实施前准确地在受控环境和现场环境中应用持久性有机污染物。
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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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