Search

Objective: This systematic review will aim to evaluate and synthesise the evidence on the impact of primary care paramedics within emergency medical services on healthcare system resource use. Introduction: Non-emergency requests to emergency medical services in Australia are estimated to make up 60% of patients of the $4.4 billion AUD services. Several programs to reduce this have been introduced, including paramedics specialising in primary care. No research currently exists synthesising the impact of these roles within emergency medical services on overall healthcare system resource use. Inclusion criteria: The study will include both analytical and observational study designs that discuss healthcare system resource use from incorporation of paramedics specialising in primary care within the emergency medical service. Methods: A systematic search will be performed using JBI methods, including a peer review of electronic search strategies. Six databases will be systematically searched: the Cochrane CENTRAL Register, PubMed, Embase, MEDLINE Complete, CINAHL, and Google Scholar. Identified studies will be independently assessed for inclusion and quality by two independent investigators using JBI critical appraisal tools. Data will be extracted for narrative and tabular synthesis. If heterogeneity permits pooling, meta-analysis to compare means will be performed using the random effects model.

Objective: The objective of this scoping review is to identify what metrics, methods and instruments are used to evaluate the impact of nurse practitioner roles. Introduction: There is much literature evaluating the impact of the nurse practitioner (NP) roles on processes and outcomes of care. Most of this literature evaluates highly specialised areas of NP practice rather than focusing on core elements of these roles. There is a critical need to clearly demonstrate the contribution of NP roles to the healthcare system and to the health of the population. To evaluate NP impact common to all roles, it is important to scope the available evidence to identify current metrics, methods, and instruments. By undertaking this review, we expect to establish an evidence base for the development of a core set of indicators sensitive to all NP models. Inclusion criteria: Articles exploring any form of NP service process outcomes will be included. Articles that report on outcomes of advanced practice nursing roles will be included if it is possible to extrapolate NP specific outcomes. Any healthcare service and area of specialty nurse practitioner practice will also be included. Methods: The proposed scoping review will be guided by the JBI methodology for scoping reviews. Peer review of quantitative, qualitative and mix method research articles in English will be performed. Medline, Cumulative Index to Nursing and Allied Health, Embase, and Scopus electronic databases will be searched. Screening of identified citations will be reviewed by a single reviewer following intra-rater reliability of 10% of citations at each stage. Data extraction will be performed using two reviewers. Results: The results of the search will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram, and a narrative summary to explain how the results relate to the review questions and objectives. Implications: Key findings from this review will be used to develop research questions and inform evaluations of the impact of NP roles on health systems and health outcomes. The results will be disseminated though peer-reviewed publication and conference presentations.

Objective: The objective of this scoping review is to summarise the evidence regarding the prevention of pulmonary complications in patients receiving mechanical ventilation in the ED Background: Mechanical ventilation is a commonly applied therapeutic intervention for critically unwell patients in the Emergency Department (ED). Ventilator associated pneumonia, acute respiratory distress syndrome and ventilator associated lung injury are some of the significant risks of receiving mechanical ventilation. Early implementation of clinical strategies can prevent or mitigate the development of pulmonary complications Method: The scoping review process will be adapted from the Joanna Briggs Institute Methodology for Scoping Reviews. Five clinical databases have been chosen for a formal literature search. A three-part grey literature search has been designed to identify clinical practice guidelines relating to ventilatory settings care of the mechanically ventilated patient in the ED published in the digital domain. Interrater reliability will be measured using percentage agreement prior to single reviewer screening of citations. Data extraction will be performed using two reviewers. Results: The results of the search and the study inclusion process will be presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for scoping review (PRISMA-ScR) flow diagram. The results of the scoping review will be presented using a tabular format with accompanying narrative summary that will describe the results in the context of the review objective and questions Implications: A summation of the evidence regarding the prevention of pulmonary complications in patients receiving mechanical ventilation in the ED will strengthen knowledge around this topic. The clinical translation of this work may result in the reduction of preventable harms and improving quality of care for the entirety of the patient journey. Keywords: mechanical ventilation, emergency, lung protective ventilation, clinical practice guideline