H Blomberg1, E Lundström, H Toss, R Gedeborg, J Johansson. 1. Department of Surgical Sciences - Anesthesiology and Intensive Care, Uppsala University Hospital, Uppsala, Sweden; Centre of Emergency Medicine, Uppsala University Hospital, Uppsala, Sweden.
Abstract
OBJECTIVES: If an ambulance nurse could bypass the emergency department (ED) and bring suspected stroke patients directly to a CT scanner, time to thrombolysis could be shortened. This study evaluates the level of agreement between ambulance nurses and emergency physicians in assessing the need for a CT scan, and interventions and monitoring beforehand, in patients with suspected stroke and/or a lowered level of consciousness. METHODS: From October 2008 to June 2009, we compared the ambulance nurses' and ED physicians' judgement of 200 patients with stroke symptoms. Both groups answered identical questions on patients' need for a CT scan, and interventions and monitoring beforehand. RESULTS: There was poor agreement between ambulance nurses and ED physicians in judging the need for a CT scan: κ = 0.22 (95% confidence interval (CI), 0.06-0.37). The nurses' ability to select the same patients as the physician for a CT scan had a sensitivity of 84% (95% CI, 77-89) and a specificity of 37% (95% CI, 23-53). Agreement concerning the need for interventions and monitoring was also low: κ = 0.32 (95% CI, 0.18-0.47). In 18% of cases, the nurses considered interventions before a CT scan unnecessary when the physicians' deemed them necessary. CONCLUSIONS: Additional tools to support ambulance nurses decisions appear to be required before suspected stroke patients can be taken directly to a CT scanner.
OBJECTIVES: If an ambulance nurse could bypass the emergency department (ED) and bring suspected strokepatients directly to a CT scanner, time to thrombolysis could be shortened. This study evaluates the level of agreement between ambulance nurses and emergency physicians in assessing the need for a CT scan, and interventions and monitoring beforehand, in patients with suspected stroke and/or a lowered level of consciousness. METHODS: From October 2008 to June 2009, we compared the ambulance nurses' and ED physicians' judgement of 200 patients with stroke symptoms. Both groups answered identical questions on patients' need for a CT scan, and interventions and monitoring beforehand. RESULTS: There was poor agreement between ambulance nurses and ED physicians in judging the need for a CT scan: κ = 0.22 (95% confidence interval (CI), 0.06-0.37). The nurses' ability to select the same patients as the physician for a CT scan had a sensitivity of 84% (95% CI, 77-89) and a specificity of 37% (95% CI, 23-53). Agreement concerning the need for interventions and monitoring was also low: κ = 0.32 (95% CI, 0.18-0.47). In 18% of cases, the nurses considered interventions before a CT scan unnecessary when the physicians' deemed them necessary. CONCLUSIONS: Additional tools to support ambulance nurses decisions appear to be required before suspected strokepatients can be taken directly to a CT scanner.
Authors: Poushali Bhattacharjee; Matthew M Churpek; Ashley Snyder; Michael D Howell; Dana P Edelson Journal: J Hosp Med Date: 2017-04 Impact factor: 2.960
Authors: M R Hov; T Nome; E Zakariassen; D Russell; J Røislien; H M Lossius; C G Lund Journal: Acta Anaesthesiol Scand Date: 2015-05-15 Impact factor: 2.105