The Use of Prehospital Intensive Care Units in Emergencies-A Scoping Review.
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ABSTRACT: Background
Amidst a rising tide of trauma-related emergencies, emergency departments worldwide grapple with the challenges of overcrowding and prolonged patient wait times. Addressing these challenges, the integration of prehospital intensive care units has appeared as a promising solution, streamlining trauma care and enhancing patient safety. Nevertheless, the feasibility of such an initiative becomes murky when considered globally. This review delves into the intricacies of prehospital intensive care units' deployment for trauma care, scrutinizing their configurations, operational practices, and the inherent challenges and research priorities.Methods
A scoping review was performed for eligible studies. The result was uploaded to the RAYYAN research platform, facilitating simultaneous evaluation of the studies by all researchers.Results
A total of 42 studies were initially selected. Four studies were duplicates, and 25 studies were unanimously removed as irrelevant. The remaining studies (n = 13) were included in the review, and the outcomes were categorized into diverse subgroups.Conclusions
A country's emergency medical services must achieve specific milestones in education, competency, resource availability, and performance to effectively harness the potential of a prehospital intensive care unit. While certain nations are equipped, others lag, highlighting a global disparity in readiness for such advanced care modalities.
SUBMITTER: Alruwaili A
PROVIDER: S-EPMC10647734 | biostudies-literature | 2023 Nov
REPOSITORIES: biostudies-literature
Publications
The Use of Prehospital Intensive Care Units in Emergencies-A Scoping Review.
Alruwaili Abdullah A Khorram-Manesh Amir A Ratnayake Amila A Robinson Yohan Y Goniewicz Krzysztof K
Healthcare (Basel, Switzerland) 20231102 21
<h4>Background</h4>Amidst a rising tide of trauma-related emergencies, emergency departments worldwide grapple with the challenges of overcrowding and prolonged patient wait times. Addressing these challenges, the integration of prehospital intensive care units has appeared as a promising solution, streamlining trauma care and enhancing patient safety. Nevertheless, the feasibility of such an initiative becomes murky when considered globally. This review delves into the intricacies of prehospita ...[more]
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| S-EPMC8600441 | biostudies-literature
Project description:IntroductionIncreasing numbers of patients are surviving critical illness, leading to growing concern about the potential impact of the long-term consequences of intensive care on patients, families and society as a whole. These long-term effects are together known as postintensive care syndrome and their presence can be evaluated at intensive care unit (ICU) follow-up consultations. However, the services provided by these consultations vary across hospitals and units, in part because there is no validated standard model to evaluate patients and their quality of life after ICU discharge. We describe a protocol for a scoping review focusing on models of ICU follow-up and the impact of such strategies on improving patient quality of life.Methods and analysisIn this scoping review, we will search the literature systematically using electronic databases (MEDLINE - from database inception to June 15th 2020) and a grey literature search. We will involve stakeholders as recommended by the Joanna Briggs Institute approach developed by Peters et al. The research will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.Ethics and disseminationThis study does not require ethics approval, because data will be obtained through a review of published primary studies. The results of our evaluation will be published in a peer-reviewed journal and will also be disseminated through presentations at national and international conferences.
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Project description:BackgroundThe aging global population and the rising prevalence of chronic disease and multimorbidity have strained health care systems, driving the need for expanded health care resources. Transitioning to home-based care (HBC) may offer a sustainable solution, supported by technological innovations such as Internet of Medical Things (IoMT) platforms. However, the full potential of IoMT platforms to streamline health care delivery is often limited by interoperability challenges that hinder communication and pose risks to patient safety. Gaining more knowledge about addressing higher levels of interoperability issues is essential to unlock the full potential of IoMT platforms.ObjectiveThis scoping review aims to summarize best practices and technologies to overcome interoperability issues in IoMT platform development for prehospital care and HBC.MethodsThis review adheres to a protocol published in 2022. Our literature search followed a dual search strategy and was conducted up to August 2023 across 6 electronic databases: IEEE Xplore, PubMed, Scopus, ACM Digital Library, Sage Journals, and ScienceDirect. After the title, abstract, and full-text screening performed by 2 reviewers, 158 articles were selected for inclusion. To answer our 2 research questions, we used 2 models defined in the protocol: a 6-level interoperability model and a 5-level IoMT reference model. Data extraction and synthesis were conducted through thematic analysis using Dedoose. The findings, including commonly used technologies and standards, are presented through narrative descriptions and graphical representations.ResultsThe primary technologies and standards reported for interoperable IoMT platforms in prehospital care and HBC included cloud computing (19/30, 63%), representational state transfer application programming interfaces (REST APIs; 17/30, 57%), Wi-Fi (17/30, 57%), gateways (15/30, 50%), and JSON (14/30, 47%). Message queuing telemetry transport (MQTT; 7/30, 23%) and WebSocket (7/30, 23%) were commonly used for real-time emergency alerts, while fog and edge computing were often combined with cloud computing for enhanced processing power and reduced latencies. By contrast, technologies associated with higher interoperability levels, such as blockchain (2/30, 7%), Kubernetes (3/30, 10%), and openEHR (2/30, 7%), were less frequently reported, indicating a focus on lower level of interoperability in most of the included studies (17/30, 57%).ConclusionsIoMT platforms that support higher levels of interoperability have the potential to deliver personalized patient care, enhance overall patient experience, enable early disease detection, and minimize time delays. However, our findings highlight a prevailing emphasis on lower levels of interoperability within the IoMT research community. While blockchain, microservices, Docker, and openEHR are described as suitable solutions in the literature, these technologies seem to be seldom used in IoMT platforms for prehospital care and HBC. Recognizing the evident benefit of cross-domain interoperability, we advocate a stronger focus on collaborative initiatives and technologies to achieve higher levels of interoperability.International registered report identifier (irrid)RR2-10.2196/40243.
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Project description:BackgroundArtificial intelligence (AI) has transformative potential to support prehospital clinicians, emergency physicians, and trauma surgeons in acute traumatic injury care. This scoping review examines the literature evaluating AI models using prehospital features to support early traumatic injury care.MethodsWe conducted a systematic search in August 2023 of PubMed, Embase, and Web of Science. Two independent reviewers screened titles/abstracts, with a third reviewer for adjudication, followed by a full-text analysis. We included original research and conference presentations evaluating AI models-machine learning (ML), deep learning (DL), and natural language processing (NLP)-that used prehospital features or features available immediately upon emergency department arrival. Review articles were excluded. The same investigators extracted data and systematically categorized outcomes to ensure consistency and transparency. We calculated kappa for interrater reliability and descriptive statistics.ResultsWe identified 1050 unique publications, with 49 meeting inclusion criteria after title and abstract review (kappa 0.58) and full-text review. Publications increased annually from 2 in 2007 to 10 in 2022. Geographic analysis revealed a 61% focus on data from the United States. Studies were predominantly retrospective (88%), used local (45%) or national level (41%) data, focused on adults only (59%) or did not specify adults or pediatrics (27%), and 57% encompassed both blunt and penetrating injury mechanisms. The majority used machine learning (88%) alone or in conjunction with DL or NLP, and the top three algorithms used were support vector machine, logistic regression, and random forest. The most common study objectives were to predict the need for critical care and life-saving interventions (29%), assist in triage (22%), and predict survival (20%).ConclusionsA small but growing body of literature described AI models based on prehospital features that may support decisions made by dispatchers, Emergency Medical Services clinicians, and trauma teams in early traumatic injury care.
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Project description:BackgroundPremature birth and the Neonatal Intensive Care Unit (NICU) experience can be challenging for parents, affecting their psychological and emotional well-being. NICU diaries could help to reduce the separation gap and strengthen the bonding process with their infant.AimTo review the literature on narrative diaries, definitions and use in the NICU.Study designWe conducted a scoping review following the Joanna Briggs Institute (JBI) methodology. We searched PubMed, Embase, Scopus, PsycINFO, Cinahl, and Grey Literature up to September 2024. Studies reporting on the use or effect of narrative diaries in the NICU were included. A descriptive and thematic analysis was conducted.ResultsOf a total of 526 records, 21 were included. Most studies had a quasi-experimental or qualitative design, including a framework conceptualization. Editorials were common. Mothers (33%), nurses (9%) and fathers (5%) were the most common diarists. Seven studies evaluated the effect of NICU diaries on family post-intensive care syndrome (PICS-F), satisfaction, and family separation. The benefits of NICU diaries for parents included improved communication, empowerment, personal emotional awareness and parental closeness with their newborn, while for staff, they reduced burnout and fostered the humanization of care. Acceptability was high.ConclusionsAcceptability and perceived benefits of NICU diaries were widely reported. Heterogeneity in aims, use, and follow-up was high. Well-designed effective multicentre studies providing evidence of impact on PICS-F and a position statement framing the intervention in NICU are recommended.Relevance to clinical practiceThis study has shown that NICU diaries have the potential to improve humanization, communication between NICU staff and parents, parents' coping, and closeness to their newborn.
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Project description:Measuring the effectiveness of nursing interventions in intensive care units has been established as a priority. However, little is reported about the paediatric population. The aims of this study were (a) to map the state of the art of the science in the field of nursing-sensitive outcomes (NSOs) in paediatric intensive care units (PICUs) and (b) to identify all reported NSOs documented to date in PICUs by also describing their metrics. A scoping review was conducted by following the framework proposed by Arksey and O'Malley. Fifty-eight articles were included. Publications were mainly authored in the United States and Canada (n = 28, 48.3%), and the majority (n = 30, 51.7%) had an observational design. A total of 46 NSOs were documented. The most reported were related to the clinical (n = 83), followed by safety (n = 41) and functional (n = 18) domains. Regarding their metrics, the majority of NSOs were measured in their occurrence using quantitative single measures, and a few validated tools were used to a lesser extent. No NSOs were reported in the perceptual domain. Nursing care of critically ill children encompasses three levels: improvement in clinical performance, as measured by clinical outcomes; assurance of patient care safety, as measured by safety outcomes; and promotion of fundamental care needs, as measured by functional outcomes. Perceptual outcomes deserve to be explored.
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Project description:ObjectivesThe objectives were to categorise the evidence, map out the existing studies and explore what was known about the organisation of paediatric intensive care units (PICUs) during the first 18 months of the COVID-19 pandemic. Additionally, this review set out to identify any knowledge gaps in the literature and recommend areas for future research.DesignScoping review.MethodsThis study used Arksey and O'Malley's six-stage scoping review framework. A comprehensive search was conducted using the following databases, CINAHL Complete; MEDLINE; PsycINFO; PsycARTICLES and EMBASE and grey literature search engines. A search strategy with predefined inclusion criteria was used to uncover relevant research in this area. Screening and data collection were done in duplicate.Results47 631 articles were obtained through searching. However, only 25 articles met the inclusion criteria and were included in the analysis. Three dominant themes emerged from the literature: (1) the reorganisation of space for managing increased capacity; (2) increased staffing and support; and (3) the resulting challenges.ConclusionCOVID-19 has strained institutional resources across the globe. To relieve the burden on intensive care units (ICUs), some PICUs adjusted their units to care for critically ill adults, with other PICUs making significant changes, including the redeployment of staff to adult ICUs to provide extra care for adults. Overall, PICUs were collectively well equipped to care for adult patients, with care enhanced by implementing elements of holistic, family-centred PICU practices. The pandemic fostered a collaborative approach among PICU teams and wider hospital communities. However, specific healthcare guidelines had to be created to safely care for adult patients.
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