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Master Thesis

Étude qualitative rétrospective des transmissions entre vecteurs extrahospitaliers et service d'accueil des urgences du CHU de la Guadeloupe

Résumé : A significant portion of patients arriving at the emergency department are brought in by firefighters and paramedics. On arrival, they transmit an assessment report including the initial clinical assessment of the patient as well as its evolution during transport, orally and in paper format. These transmissions are important for the initial orientation of the patient by the emergency referral and reception nurse within the emergency department and for future management. Objective: The objective of our study is to evaluate the quality of these transmissions (oral and written) to Guadeloupe Pubic Hospital (CHU) and to propose solutions for improvements. Method: A retrospective study of the firefighter balance sheets (paper format) for the period from 1 to 31 October 2017 was carried out as well as a qualitative study of the perception of the transmissions by the firefighters and emergency nurses via questionnaires. The main objective is to evaluate the quality of the transmissions written by the filling rate of the balance sheets. Secondary objectives include studying the perception of firefighters and nurses of transmissions. Results: 467 Firefighter balance sheets were studied. None was filled completely. According to the criteria established in the study for an incomplete filling but sufficient for the evaluation and the orientation of the patient 2 balance sheets out of 467 (0.4%) were exploitable by taking 7 items of the form in consideration, 64 (14%) in taking 5 items in consideration. The circumstantial balance sheet and the initial diagnostic hypothesis were accorded for 344 cards (77%). The average filling for each part is 77% for the consciousness, 67% for the ventilation, 61% for the circulation and 58% for the complementary balance. The cards were less filled in the case where the SMUR intervened on the spot (34 sheets). The hour of intervention was specified on 67 sheets (14%). 55 firefighter’s questionnaires have been completed. 35 (64%) of them consider that they do not have a specific pathway for emergencies, 12 (22%) have a waiting time greater than 20 minutes between arrival and supported by emergency nurse. 34 (62%) stated that they had to provide additional oral information during the transmission, 45 (82%) are interested in a simplified form sheet common to both services. 14 questionnaires were completed by the nurses. 12 nurses (86%) feel a lack of essential elements to assess the severity of the patient. They all expressed the need for additional information for a better orientation of the patient. According to 13 nurses (93%) the reason for intervention given by firefighters is not precise, 12 (86%) are interested in a common simplified form sheet. Conclusion: A simplification of the sheet would be desirable for a better filling, common training to firefighters and emergency nurses would allow a better communication.
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Master Thesis
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Camille Bruneel. Étude qualitative rétrospective des transmissions entre vecteurs extrahospitaliers et service d'accueil des urgences du CHU de la Guadeloupe. Médecine humaine et pathologie. 2019. ⟨dumas-02497497⟩

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