2 research outputs found
Intégration des apprenants paramédicaux et infirmiers d’urgence dans une simulation d’équipe de traumatologie sur place
No full textThe COVID-19 and its associated restrictions and closures provided challenges to health professions education programs in creating suitable clinical experiences to allow consolidation and application of the concepts learned from the classroom. While in situ simulation has been well-established for continuing education with active clinical teams, there is a paucity in literature describing the integration of health professions learners in an in situ simulation. This created an opportunity to integrate learners from paramedic and postgraduate emergency nursing programs to participate in an in situ simulation with active clinical team members of an Canadian academic tertiary trauma center. A series of high fidelity simulations were designed and implemented with paramedic learners performing the initial assessment and management in the prehospital phase and subsequently handing over to a receiving team inside a trauma center. Preliminary feedback solicited from participants indicated that this was a valuable learning experience and provided an opportunity to practice technical and nontechnical skills.La COVID-19 et les restrictions et fermetures qui y sont associées ont posé des défis aux programmes de formation des professions de santé pour créer des expériences cliniques adaptées permettant de consolider et d\u27appliquer les concepts appris en classe. Bien que la simulation in situ soit bien établie pour la formation continue des équipes cliniques actives, il y a une rareté dans la littérature décrivant l\u27intégration des apprenants des professions de santé dans une simulation in situ. Cela a créé une opportunité d\u27intégrer des apprenants des programmes de soins paramédicaux et des programmes de formation en soins infirmiers d\u27urgence de troisième cycle pour participer à une simulation in situ avec des membres actifs d\u27une équipe clinique d\u27un centre de traumatologie universitaire canadien. Une série de simulations haute fidélité ont été conçues et mises en œuvre, avec des apprenants paramédicaux effectuant l\u27évaluation initiale et la gestion en phase préhospitalière, puis transférant le relais à une équipe de réception à l\u27intérieur d\u27un centre de traumatologie. Les retours préliminaires recueillis auprès des participants ont indiqué que cela représentait une expérience d\u27apprentissage précieuse et offrait une opportunité de pratiquer des compétences techniques et non techniques
Reducing redundant creatine kinase testing in cardiac injury
No full textBackground Creatine kinase (CK) testing in the setting of suspected cardiac injury is commonly performed yet rarely provides clinical value beyond troponin testing. We sought to evaluate and reduce CK testing coupled with troponin testing by 50% or greater.Methods We performed root cause analysis to study prevailing processes and patterns of CK testing. We developed new institutional guidelines, removed CK from high-volume paper and electronic order bundles and conducted academic detailing for departments with highest ordering frequency. We evaluated consecutive patients at Sunnybrook Health Sciences Centre between 1 January 2018 and 31 March 2020 who had either a CK or troponin level measured. We prespecified successful implementation as a reduction of 50% in total CK orders and a decrease in the ratio of CK-to-troponin tests to one-third or less. We retained additional data beyond our study period to assess for sustained reductions in testing.Results Total CK tests decreased over the study period from 3963 to 2111 per month, amounting to a 46.7% reduction (95% CI 33.2 to 60.2; p<0.001) equalling 61 fewer tests per hospital day. Troponin testing did not significantly change during the intervention. Ratio of CK-to-troponin tests decreased from 0.91 to 0.49 (p<0.001). The reduction coincided with changes to order-sets, was observed across all clinical units and was sustained during additional months beyond the study period. These reductions in testing resulted in a projected annual cost savings of C$28 446.Conclusions We demonstrate that a low-cost and feasible quality improvement initiative may lead to significant reduction in unnecessary CK testing and substantial savings in healthcare costs for patients with suspected cardiac injury
