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Validation of an emergency triage scale for obstetrics and gynaecology: a prospective study

Share your thoughts with other customers. Write a customer review. Discover the best of shopping and entertainment with Amazon Prime. Prime members enjoy FREE Delivery on millions of eligible domestic and international items, in addition to exclusive access to movies, TV shows, and more. Back to top. Get to Know Us. For example, one hospital implemented a rapid response team for obstetric emergencies, whereby diagnosis of fetal bradycardia requires urgent transfer to the operating room with the expectation that many instances of bradycardia will resolve and not require emergent cesarean delivery 5.

Anaesthesia ;— Used with permission. The protocol should provide for a full evaluation of the problem. Training all staff in a formal emergency communication process, using a standardized communication tool such as SBAR Situation—Background—Assessment—Recommendation , may further optimize effective response to a patient care issue. Lack of teamwork and suboptimal communication have been cited as the leading cause of perinatal and maternal death 6.

Standardized responses and practices will increase the efficiency of care and allow a continuous quality improvement process to accurately assess the effectiveness of the interventions. Rapid response teams may include advanced practice nurses, respiratory therapists, and first responders who approach the scenario in a standardized fashion. The activation of a rapid response team should be simultaneous with the event. All regular clinical team members have the authority to activate a rapid response team when a critical event or criteria are noted, or for any potential serious emergency in which a team response is required 5.

By designating criteria that define an emergency, it becomes clear when to call for help, thus increasing the utilization of the rapid response team 3—5. This contrasts with the conventional, serial chain of command that traditionally was followed before an intervention could be initiated. Early activation of a rapid response team has been associated with a decrease in cardiac arrest, improved survival of hospitalized patients, and decreased admissions to an intensive care unit 7.

It is important to emphasize that calling a resident physician in a teaching hospital is not a substitute for triggering a rapid response team intervention.

Emergencies in obstetrics and gynaecology | College of Physicians and Surgeons of British Columbia

Similarly, calling the in-house physician in a nonteaching setting does not substitute activating a rapid response team intervention. Establishing a rapid response team is a multistep process 3, 8 , 9. Clinicians, support staff, and stakeholders must be identified; this may include the page operator, as well as staff in the blood bank or the hospital laboratory 5. Criteria for activation of a rapid response team should be determined.

Debriefing, with feedback and process improvement, must be established 5. Finally, the effectiveness of the rapid response team process should be evaluated on a regular basis. A rapid response team can be divided into four components: 1 activators, 2 responders, 3 quality improvement, and 4 administration 8. Activators are individuals who may activate the rapid response team, and may include clinicians, specialists, or clerical staff.

Team members from the nursing staff or floor staff are trained to monitor for disturbances that require activation of the rapid response team. Responders are clinicians who arrive at the bedside, along with the attending physician, to stabilize the patient and determine her disposition. Options may include transfer to a higher level of care, revision of the current treatment plan, or a handoff to the primary nurse or physician. When the responders arrive, the activators must be prepared to exchange information. A communication protocol such as SBAR allows team members to exchange information in a clear and concise manner.

This will help ensure that expeditious care is provided to the patient. Early in the response phase, a discussion, or brief, should be conducted to assign essential roles, establish expectations, and anticipate outcomes and possible contingencies. The primary purpose of the communication protocol is to exchange critical patient information and establish a treatment plan.

A team huddle, designed to reinforce plans already in place and to assess the need to adjust the plan, also may be used to review situational awareness and to troubleshoot and revise the current plan of action, if needed. A check-back closed loop communication strategy used to verify and validate information exchanged , a time-out planned period of quiet and interdisciplinary discussion focused on ensuring that key procedural details have been addressed , or a call out strategy used to communicate important or critical information may be used to ensure closed loop communication.

Team members should be debriefed after the event in an effort to evaluate and improve their response. The quality improvement team reviews the activation, implementation, and outcomes of the rapid response team. Their assessment and recommendations are formulated into an action review, which may be implemented by administration Resources for setting up such an initiative, as well as other resources, may be found on the web sites of these organizations. Successful implementation of a rapid response team may involve overcoming logistic, political, institutional, social, financial, or anthropologic barriers.

Leadership from senior medical and nursing personnel is crucial The principle that standardized care can result in safer care applies to emergency situations as well as to routine care. This training may use a comprehensive curriculum that addresses communication strategies such as TeamSTEPPS 12 or a less structured teamwork model or a curriculum that focuses on specific clinical scenarios, such as shoulder dystocia.

A sophisticated simulated environment or an everyday workspace can meet the needs of the trainees as long as it mirrors the existing clinical setting and resources.


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By conducting a drill in the actual patient care setting, issues related to the physical environment may become obvious. Simulation training can identify and correct common clinical errors made during emergencies Protocols, activation criteria, and critical interventions can be reinforced by being posted on walls, printed on pocket cards, or uploaded as screen savers to promote a sustained culture of safety. Emergency drills allow team members to practice effective communication in a crisis.

Adult learning theory supports the importance of experiential learning. Many aspects of the medical environment may compromise effective communication, including a hierarchical hospital structure, emotional intensity and stress of a situation, and the range of educational backgrounds and clinical understanding of various team members. Completed disclosure of interests form available to view online as supporting Information. NVR managed the data, including quality control.

AGA provided statistical advice on study design. NVR takes responsibility for the paper as a whole. The study was submitted to and approved in by the local Ethics Committee of the Geneva University Hospitals no.

Edited by S Arulkumaran

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Emergency Obstetric Kit

Design Thirty clinical vignettes presenting the most frequent indications for obstetrics and gynaecology emergency consultations were evaluated twice using a computerised simulator. Setting The study was performed at the emergency unit of obstetrics and gynaecology at the Geneva University Hospitals. Sample The vignettes were submitted to nurses and midwives. Main outcome measures Triage acuity. Results We obtained a total of evaluations.

Tweetable abstract The Swiss Emergency Triage Scale is a valid and reliable tool for obstetrics and gynaecology emergency triage. Introduction Triage is the preliminary clinical assessment process that sorts patients before full diagnosis and treatment and has become crucial in times of overcrowded emergency units and resource constraints. Statistical analysis Because we were constrained by the number of participants and the number of clinical vignettes, we estimated that the expected variance for an expected ICC between 0.

Results We obtained a total of ratings Evaluation of the triage process We observed a wide variability in the median IQR number of questions asked per vignette, ranging from 8. Figure 1 Open in figure viewer PowerPoint. Variability in the number of questions asked per vignette A , and in the number of questions asked per participant B. Triage performance evaluation in the test phase Perfect agreement between the expected and the observed triage decisions was found in Discussion Main findings We were able to confirm the reliability of the SETS in an obstetrics and gynaecology setting and to explore the performance of nurses and midwives in the triage process.

Strengths and limitations Compared with other available triage instruments in obstetrics and gynaecology, the SETS has the advantage of being an integrated scale based on an extensively tested system in a general emergency department. Disclosure of interests None declared. Details of ethics approval The study was submitted to and approved in by the local Ethics Committee of the Geneva University Hospitals no. Funding The study was supported by funds from the Geneva University Hospitals for quality projects. Thirty scenarios included in the triage simulator.

J Emerg Nursing ; 25 : — Crossref PubMed Google Scholar. Google Scholar.


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