Experiences of emergency triage nurses in the police handover of mentally ill patients: A qualitative descriptive study.

BACKGROUND: Due to the high prevalence of mental health illnesses, police officers are often the community resource to emergency calls for someone experiencing a mental health crisis. Despite the successful efforts of crisis intervention teams, the police frequently escort and transfer the individual in crisis to the emergency department (ED). To our knowledge, one study has explored the interactions of first responders and ED staff; however, we lack an understanding of ED triage nurse experiences. AIM: To explore the experiences of ED triage nurses regarding the handover of a mental health patient by police in a Quebec University Health Center. METHOD: Semi-structured interviews with seven nurses were thematically analyzed. The COREQ checklist for reporting qualitative research was used. RESULTS: Nurses and police officers are both concern about patient's well-being; yet, their approach, as discussed in the theme "Medical versus Legal Responsibility", varied based on their differing responsibilities and views of caring versus protecting. Despite a need for ED-triage protocols, as described in the theme "Ambiguities of Existing ED-Triage Protocols", all nurses saw police officers as fellow colleagues and expressed that a change had taken place in police culture towards mental health. The latter issues are explained in the themes "Interagency Collaboration and Team-Based Approach", and "Changing Police Culture on Mental Health." CONCLUSION: There is a need for inter-professional collaboration and education to better understand the roles and scope of practice of both professions, and ED triage nurses should receive more training in the domain of mental health.

A Randomized Trial Comparing Telephone Tree, Text Messaging, and Instant Messaging App for Emergency Department Staff Recall for Disaster Response.

IntroductionA crucial component of a hospital's disaster plan is an efficient staff recall communication method. Many hospitals use a "calling tree" protocol to contact staff members and recall them to work. Alternative staff recall methods have been proposed and explored. METHODS: An unannounced, multidisciplinary, randomized emergency department (ED) staff recall drill was conducted at night - when there is the greatest need for back-up personnel and staff is most difficult to reach. The drill was performed on December 14, 2017 at 4:00am and involved ED staff members from three hospitals which are all part of the McGill University Health Centre (MUHC; Montreal, Quebec, Canada). Three tools were compared: manual phone tree, instant messaging application (IMA), and custom-made hospital Short Message Service (SMS) system. The key outcome measures were proportion of responses at 45 minutes and median response time. RESULTS: One-hundred thirty-two participants were recruited. There were 44 participants in each group after randomization. In the manual phone tree group, 18 (41%) responded within 45 minutes. In the IMA group, 11 participants (25%) responded in the first 45 minutes. In the SMS group, seven participants responded in the first 45 minutes (16%). Manual phone tree was significantly better than SMS with an effect size of 25% (95% confidence interval for effect: 4.6% to 45.0%; P=.018). Conversely, there was no significant difference between manual phone tree and IMA with an effect size of 16% (95% confidence interval for effect: -5.7% to 38.0%; P=.17) There was a statistically significant difference in the median response time between the three groups with the phone tree group presenting the lowest median response time (8.5 minutes; range: 2.0 to 8.5 minutes; P=.000006). CONCLUSION: Both the phone tree and IMA groups had a significantly higher response rate than the SMS group. There was no significant difference between the proportion of responses at 45 minutes in the phone tree and the IMA arms. This study suggests that an IMA may be a viable alternative to the traditional phone tree method. Limitations of the study include volunteer bias and the fact that there was only one communication drill, which did not allow staff members randomized to the IMA and SMS groups to fully get familiar with the new staff recall methods. HomierV, HamadR, LarocqueJ, ChasséP, KhalilE, FrancJM. A randomized trial comparing telephone tree, text messaging, and instant messaging app for emergency department staff recall for disaster response. Prehosp Disaster Med. 2018;33(5):471-477.