Communicatie en ABCDE-benadering op de Spoedeisende Hulp, pilotstudie.

Grinsven-Sidorov, E. van (Egor) (2015) Communicatie en ABCDE-benadering op de Spoedeisende Hulp, pilotstudie. thesis, Medicine.

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Abstract

Introduction: At the University Medical Center Groningen (UMCG), intensive training is given to the medical personnel. Because of the potential complex presentation of patients at the Emergency Department (ED), doctors and nurses are trained in coping with complex emergency situations. Key points of these (simulation) training exercises are primary assessment according to the Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach. Communication training is given following the Situation Background Assessment, Recommendation (SBAR) method. So far, it is unknown to what extent these training exercises are applied in practice. Objective: Measuring of the practical implementation of trained capacities such as ABCDE-approach and the communication towards the treating physicians by the nursing staff of the ED and to identify potential causes and effects of this for the patient. Methods: By preforming a prospective observational pilot research at the ED, non-trauma patients of the internal and emergency medical departments were observed. Only urgent (code yellow) and very urgent (code orange) of these specialized departments were included. The first 60 minutes from the moment the patient was placed in the treatment room were observed. The completeness of the ABCDE approach was verified by the validated checklist. The communication by nurses towards the relevant treating physicians was measured by a customized checklist developed by the author (inspired by SBAR). The potential causes and effects of these activities were analyzed. The utilized parameters were: time until the treating physician arrives, time until the hydration therapy starts and the time until radiological research. Results: In total, 92 patients were screened during the research and the final relevant study population consisted of 89 patients. Parts of the ABCDE criteria were applied on all patients and the average completeness of the checklist amounted to 5 and 6 (21%) of the 26 components in total. Furthermore, 12 of the 26 components were not observed at all. Only the measurement of vital parameters were consistently observed. In more than 80 % of the cases only the vital parameters were performed. A positive weak correlation (rs = 0.220, p = 0.019) was established between the completeness of the ABCDE checklist and initial clinical impression score (CIS) of the nursing staff. Communication towards treating physician was performed in 24 (27%) of 89 cases, and was fully completed in 3 instances. There was no difference in frequency of communication between groups of patients with or without deviating vital parameters (p = 1.000) or between different urgency codes (p = 0.586). A higher CIS resulted in more frequent (p = 0.028) communication. Moreover, there was a weak positive correlation between the height of the CIS and the completeness of the communication (rs = 0.237, p = 0.025). It has not been shown that communication has influence on time until treating physician arrives (p = 0.065). Also no influence was found on the time until hydrationtherapy or radiologial research. Conclusion: Despite the frequent and intensive training of the UMCG medical personel, the learned capabilities are inconsistently implemented in practice. The ABCDE approach is executed imcompletely and the communication towards treating physicians is not frequently performed. It has not been shown, however, that this results in adverse effects on medical care standards. The first impression of the nursing staff has proven to be a significant factor in the extent of implementation the learned capacities.

Item Type:	Thesis (Thesis)
Supervisor name:	Olgers, drs. T.J. and Maaten, dr. J.C. ter
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 11:02
Last Modified:	25 Jun 2020 11:02
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/2255

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