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Use of checklists improves the quality and safety of prehospital emergency care
Thoralf Kerner1, Willi Schmidbauer, Mares Tietz
1aDepartment of Anaesthesiology, Intensive Care Medicine, Emergency Medicine and Pain Therapy bInstitute for Emergency Medicine, Asklepios Kliniken Hamburg cDepartment of Anaesthesiology and Intensive Care Medicine, Bundeswehrkrankenhaus Hamburg, Hamburg dDepartment of Emergency Medicine, Bundeswehrkrankenhaus Berlin, Berlin eClinic of Anaesthesiology and Intensive Care Medicine, Neckar-Odenwald-Kliniken gGmbH, Buchen, Germany.
Objectives:
High-level emergency medical care requires transfer of evidence-based knowledge into practice. Our study is the first to investigate the feasibility of checklists in improving prehospital emergency care.
Materials And Methods:
Three checklists based on standard operating procedures were introduced: General principles of prehospital care, acute coronary syndrome and acute asthma/acutely exacerbated chronic obstructive pulmonary disease. Subsequent to prehospital care and immediately before transport, information on medical history, diagnostic and therapeutic procedures was obtained. Data of 740 emergency missions were recorded prospectively before (control group) and after implementation of checklists and compared using the χ-test (significance level P<0.05).
Results:
Documentation on patients' history (pre-existing diseases: 69.1 vs. 74.3%; medication: 55.8 vs. 68.0%; allergies: 6.2 vs. 27.7%) and diagnostic measures (oxygen saturation: 93.2 vs. 98.1%; auscultation: 11.1 vs. 19.9%) as well as basic treatment procedures (application of oxygen: 73.2 vs. 85.3%; intravenous access: 84.6 vs. 92.2%) increased significantly. Subanalysis of acute coronary syndrome cases showed a significant increase of 12-lead ECG use (74.3 vs. 92.4%), administration of oxygen (84.2 vs. 98.6%), ASA (71.7 vs. 81.9%), heparin (71.1 vs. 84.0%), β blockers (39.5 vs. 57.1%) and morphine (26.8 vs. 44.6%). In the chronic obstructive pulmonary disease subgroup, oxygen supply (78.8 vs. 98.5%) and application of inhalative and intravenous β2-mimetics (42.4 vs. 66.7% and 12.1 vs. 37.9%) increased significantly.
Conclusion:
Introduction of checklists for prehospital emergency care may help to improve adherence to treatment guidelines. Additional efforts (e.g. team trainings) have to be made to increase quality of care.
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