Academic emergency medicine : official journal of the Society for Academic Emergency Medicine
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Multicenter Study Comparative Study
Multivariate predictors of failed prehospital endotracheal intubation.
Conventionally trained out-of-hospital rescuers (such as paramedics) often fail to accomplish endotracheal intubation (ETI) in patients requiring invasive airway management. Previous studies have identified univariate variables associated with failed out-of-hospital ETI but have not examined the interaction between the numerous factors impacting ETI success. This study sought to use multivariate logistic regression to identify a set of factors associated with failed adult out-of-hospital ETI. ⋯ The authors used multivariate logistic regression to identify a set of factors associated with failure to accomplish ETI in adult out-of-hospital patients. Findings from this analysis could provide the basis for clinical protocols or decision rules aimed at minimizing the incidence of out-of-hospital ETI failure.
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Comparative Study
Customer satisfaction measurement in emergency medical services.
The annual patient volume in emergency medical services (EMS) systems is high worldwide. However, there are no comprehensive studies on customer satisfaction for EMS. The authors report how a customer satisfaction survey on EMS patients was conducted, the results, and the possible causes for dissatisfaction. ⋯ This study shows that customer satisfaction surveys can be successfully conducted for EMS. EMS systems should consider routinely using customer satisfaction surveys as a tool for quality measurement and improvement.
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This study evaluated a sample of emergency department (ED) patients for history of violence and substance abuse. ⋯ A large percentage of injured patients in this urban ED experienced violence in the past year. Alcohol and illicit drugs appear to be concomitant with violence.
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To determine the effect of simultaneous ambulance diversion at multiple emergency departments (EDs) (gridlock) on transport delays for patients with chest pain. ⋯ Ambulance diversion was associated with delays in out-of-hospital ambulance transport for chest pain patients, but only when it resulted in gridlock. The magnitude of the out-of-hospital delay was the same regardless of the patient's severity of illness.
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The performance of out-of-hospital systems is frequently evaluated based on the times taken to respond to emergency requests and to transport patients to hospital. The 90th percentile is a common statistic used to measure these indicators, since they reflect performance for most patients. Traditional regression models, which assess how the mean of a distribution varies with changes in patient or system characteristics, are thus of limited use to researchers in out-of-hospital care. ⋯ In other words, ambulance diversion disproportionately affects those patients who already have longer transport intervals. Second, the distribution of transport intervals, conditional on a given set of variables, is positively skewed, and not uniformly or symmetrically distributed. The flexibility of quantile regression models makes them particularly well suited to out-of-hospital research, and they may allow for more relevant evaluation of out-of-hospital system performance.