Los rasgos de personalidad de los médicos de emergencia y paramédicos.
Personality traits of emergency physicians and paramedics Frank-Gerald Pajonk, Burghard Andresen, Thomas Schneider-Axmann, Alexander Teichmann, Ulf Gartner, Jurgen Lubda, Heinzpeter Moecke, Georg von Knobelsdorff
Emerg Med J 2011;28:141e146. doi:10.1136/emj.2009.083311 Abstract Objective Personality influences behaviour and decision making This may play a particular role in emergency medical personnel (EMP) dealing with critical situations. So far very little is known about personality traits that distinguish paramedics (PM) and emergency physicians (EP) from other medical staff. Methods A questionnaire including the ultra-short version of the Hamburg Personality Inventory (HPA) was distributed to EP, PM, medical doctors not practicing emergency medicine (MD) and medical students (MS). Results 274 EPs, 245 PMs, 48 MDs and 60 MSs returned the questionnaire. Four personality clusters in EPs and PMs were identified and to be found largely independent from demographic and job-related variables. For both groups one cluster revealed personality characteristics that seem particularly suitable for EMP ('resilient crisis manager'). 'Anxious' and 'insecure' personality traits were found in two clusters in PMs and in one cluster in EPs. Mental health problems in the participants or their relatives or the experience of loss increased scores in the dimensions neuroticism and openness. Conclusions The personality characteristics of EPs and PMs are not homogenous and do not differ substantially from those of MDs and MSs. 50e70% of EMP can be characterised as 'resilient and stable', up to 30e40% as 'anxious and insecure'. The presence of mental health problems in participants or their relatives or the experience of loss may lead to openness for new experiences and alternative behaviour or e on the other hand e may trigger feelings of insecurity and/or anxiety in emergency situations. http://emj.bmj.com/content/28/2/141.full.pdf
Proveedor de la eficiencia en medicina de emergencia: el equilibrio de la curva de aprendizaje, y el punto de los rendimientos decrecientes
Emergency medicine provider efficiency: the learning curve, equilibration and point of diminishing returns Emerg Med J 2010;27:916-920 doi:10.1136/emj.2009.079194
Abstract Objective This study described the spectrum of emergency department (ED) physician performance correlating annual workload, experience and facility issues. Methods Retrospective review reported physician hours worked comparing productivity measures-patients per hour (PPH) or relative value unit (RVU) per hour, as 'best fit' trend line and facility volume subgroups by analysis of variance. Conclusion Maximal productivity is reached at 86% (1550 h) annual workload and efficiency declines at conventional FTE 1800 h. A distinct 'learning curve' was found in newer, casual providers and smaller facilities.
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Efecto de la designación del médico en el desempeño de urgencias vía rápida (Fast track)
Effect of clinician designation on emergency department fast track performance Julie Considine, Matthew Kropman, Helen E Stergiou. Emerg Med J 2010;27:838-842 doi:10.1136/emj.2009.083113
Abstract Objective To examine the effect of clinician designation on emergency department (ED) fast track performance. Design and Setting A retrospective audit of patients managed in the fast track area of an ED in metropolitan Melbourne, Australia. Participants Patients triaged to ED fast track from 1 January 2008 to 31 December 2008 (n=8714). Main Outcome Measures Waiting times in relation to Australasian triage scale (ATS) recommendations and ED length of stay (LOS) for non-admitted patients were examined for each clinician group. Results Compliance with ATS waiting time recommendations was highest (82.5%) for emergency nurse practitioners/candidates and lowest (48.2%) for junior medical officers. Median ED LOS was less than 3 h for non-admitted patients, and 85.8% of non-admitted fast track patients (n=6278) left the ED within 4 h. Patients managed by emergency nurse practitioners/candidates had the shortest ED LOS (median 1.7 h) and patients managed by junior medical officers and locum medical officers the longest ED LOS (median 2.7 h) (χ2=498.539, df=6, p<0.001). Conclusions Clinician designation does impact on waiting times and, to a lesser extent, ED LOS for patients managed in ED fast track systems. Future research should focus on obtaining a better understanding of the relationship between clinician expertise, time-based performance measures and quality of care indicators.