Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-17T11:23:26.424Z Has data issue: false hasContentIssue false
  • English
  • Français

Consensus on paramedic clinical decisions during high-acuity emergency calls: results of a Canadian Delphi study

Published online by Cambridge University Press:  11 May 2015

Jan L. Jensen ,
Pat Croskerry  and
Andrew H. Travers
Jan L. Jensen*
Affiliation:
Division of Emergency Medical Services, Dalhousie University, Halifax, NS Emergency Health Services, Dartmouth, NS
Pat Croskerry
Affiliation:
Department of Emergency Medicine, Dalhousie University, Halifax, NS Capital District Health Authority, Halifax, NS
Andrew H. Travers
Affiliation:
Emergency Health Services, Dartmouth, NS Department of Emergency Medicine, Dalhousie University, Halifax, NS Capital District Health Authority, Halifax, NS
*
Division of Emergency Medical Services, Dalhousie University, QEII Health Sciences Centre, 1796 Summer Street, Room 3022, Halifax, NS B3H 3A7; [email protected]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Objectives:

To establish consensus on the most important clinical decisions paramedics make during high-acuity emergency calls and to visualize these decisions on a process map of an emergency call. A secondary objective was to measure agreement among paramedics and medical director panel members.

Methods:

A multiround online survey of Canadian paramedics and medical directors. In round 1, participants listed important clinical decisions. In round 2, participants scored each decision in terms of its importance for patient outcome and safety. In rounds 3 and 4, participants could revise their scores. Consensus was defined a priori: 80% or more agreement that a decision was important or extremely important. The included decisions were plotted on a process map of a typical emergency call.

Results:

The panel response rates were as follows: round 1, 96%; round 2, 92%; round 3, 83%; and round 4, 96%. Consensus was reached on 42 decisions, grouped into six categories: airway management (n = 13); assessment (n = 3); cardiac management (n = 7); drug administration (n = 9); scene management (n = 4); and general treatment (n = 6). The on-scene treatment phase of the process map was found to have the highest decision density. Paramedics and medical directors differed in their scoring in 5 of 42 decisions (p < 0.05 or less).

Conclusion:

Consensus was reached among paramedics and medical directors on 42 decisions important for clinical outcome and patient safety. These decisions were visualized on a process map of an emergency call to learn more about where decision density exists during a typical call.

Keywords

decision makingDelphiemergency medical servicesparamedics
Type
Original Research • Recherche originale
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 5 , September 2011 , pp. 310 - 318
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Croskerry, P, Sinclair, D. Emergency medicine: a practice prone to error? CJEM 2001;3:271–6.Google Scholar
2.O'Connor, RE, Slovis, CM, Hunt, RC, et al. Eliminating errors in emergency medical services: realities and recommendations. Prehosp Emerg Care 2002;6:107–13, doi:10.1080/ 10903120290938913.CrossRefGoogle ScholarPubMed
3.Wang, HE, Lave, JR, Sirio, CA, et al. Paramedic intubation errors: isolated events or symptoms of larger problems? Health Aff 2006;25:501–9, doi:10.1377/hlthaff.25.2.501.CrossRefGoogle ScholarPubMed
4.Hobgood, C, Xie, J, Weiner, B, et al. Error identification, disclosure, and reporting: practice patterns of three emergency medicine provider types. Acad Emerg Med 2004;11:196–9.Google Scholar
5.Wang, HE, Katz, SH. Cognitive control and prehospital endotracheal intubation. Prehosp Emerg Care 2007;11:234–9, doi:10.1080/10903120701204987.CrossRefGoogle ScholarPubMed
6.Fairbanks, RJ, Crittenden, CN, O'Gara, KG, et al. Emergency medical services provider perceptions of the nature of adverse events and near misses in out-of-hospital care: an ethnographic view. Acad Emerg Med 2008;15:633–40, doi:10.1111/j.1553-2712.2008.00147.x.CrossRefGoogle ScholarPubMed
7.Atack, L, Maher, J. Emergency medical and health providers' perceptions of key issues in prehospital patient safety. Prehosp Emerg Care 2010;14:95–102, doi:10.3109/ 10903120903349887.CrossRefGoogle ScholarPubMed
8.Online survey service. Opinio, 2007. Available at: http://its.dal.ca/services/other_services/online_surveys/ (accessed April 1, 2007).Google Scholar
9.Goodman, CM. The Delphi technique: a critique. JAdvNurs 1987;12:729–34, doi:10.1111/j.1365-2648.1987.tb01376.x.Google Scholar
10.Hasson, F, Keeney, S, McKenna, H. Research guidelines for the Delphi survey technique. J Adv Nurs 2000;32:1008–15.Google Scholar
11.Williams, PL, Webb, C. The Delphi technique: a methodological discussion. JAdv Nurs 1994;19:180–6, doi:10.1111/ j.1365-2648.1994.tb01066.x.Google ScholarPubMed
12.Klotz, L. The impact of process mapping on transparency. Int J Product Perform Mgt 2008;57:623, doi:10.1108/ 17410400810916053.CrossRefGoogle Scholar
13.Jensen, JL, Croskerry, P, Travers, AH. Paramedic clinical decision making during high acuity emergency calls: design and methodology of a Delphi study. BMC Emerg Med 2009;9:17, doi:10.1186/1471-227X-9-17.Google Scholar
14.Kassirer, JP, Kopelman, RL. Learning clinical reasoning from examples. Hosp Pract 1989;24:27, 32-4, 44-5.Google ScholarPubMed
15.Croskerry, P, Cosby, KS, Schenkel, SM, Wears, RL, editors. Patient safety in emergency medicine. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2009.Google Scholar
16.Blanchard, I, Clayden, D, Vogelaar, G, et al. Adult prehospital rapid-sequence intubation process map: a clinical management tool. Prehosp Emerg Care 2009;13:126, doi:10.1080/ 10903120903144973.Google Scholar
17.Crisp, J, Pelletier, D, Duffield, C, et al. The Delphi method? Nurs Res 1997;46:116, doi:10.1097/00006199-199703000-00010.Google Scholar