[Health simulation, access to somatic care for people with ASD]. / Simulation en santé et accès aux soins somatiques des personnes présentant un TSA.

The clinical characteristics of people with autism spectrum disorders can make it difficult for them to access care, including treatment and medical imaging examinations. Simulation-based learning can facilitate the performance of a CT scan, as in the case of Irène, who was able to adopt the expected body positions thanks to this intervention.

Predictive models in emergency medicine and their missing data strategies: a systematic review.

In the field of emergency medicine (EM), the use of decision support tools based on artificial intelligence has increased markedly in recent years. In some cases, data are omitted deliberately and thus constitute "data not purposely collected" (DNPC). This accepted information bias can be managed in various ways: dropping patients with missing data, imputing with the mean, or using automatic techniques (e.g., machine learning) to handle or impute the data. Here, we systematically reviewed the methods used to handle missing data in EM research. A systematic review was performed after searching PubMed with the query "(emergency medicine OR emergency service) AND (artificial intelligence OR machine learning)". Seventy-two studies were included in the review. The trained models variously predicted diagnosis in 25 (35%) publications, mortality in 21 (29%) publications, and probability of admission in 21 (29%) publications. Eight publications (11%) predicted two outcomes. Only 15 (21%) publications described their missing data. DNPC constitute the "missing data" in EM machine learning studies. Although DNPC have been described more rigorously since 2020, the descriptions in the literature are not exhaustive, systematic or homogeneous. Imputation appears to be the best strategy but requires more time and computational resources. To increase the quality and the comparability of studies, we recommend inclusion of the TRIPOD checklist in each new publication, summarizing the machine learning process in an explicit methodological diagram, and always publishing the area under the receiver operating characteristics curve-even when it is not the primary outcome.

Use of Artificial Intelligence to Manage Patient Flow in Emergency Department during the COVID-19 Pandemic: A Prospective, Single-Center Study.

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, calculation of the number of emergency department (ED) beds required for patients with vs. without suspected COVID-19 represented a real public health problem. In France, Amiens Picardy University Hospital (APUH) developed an Artificial Intelligence (AI) project called "Prediction of the Patient Pathway in the Emergency Department" (3P-U) to predict patient outcomes. MATERIALS: Using the 3P-U model, we performed a prospective, single-center study of patients attending APUH's ED in 2020 and 2021. The objective was to determine the minimum and maximum numbers of beds required in real-time, according to the 3P-U model. Results A total of 105,457 patients were included. The area under the receiver operating characteristic curve (AUROC) for the 3P-U was 0.82 for all of the patients and 0.90 for the unambiguous cases. Specifically, 38,353 (36.4%) patients were flagged as "likely to be discharged", 18,815 (17.8%) were flagged as "likely to be admitted", and 48,297 (45.8%) patients could not be flagged. Based on the predicted minimum number of beds (for unambiguous cases only) and the maximum number of beds (all patients), the hospital management coordinated the conversion of wards into dedicated COVID-19 units. DISCUSSION AND CONCLUSIONS: The 3P-U model's AUROC is in the middle of range reported in the literature for similar classifiers. By considering the range of required bed numbers, the waste of resources (e.g., time and beds) could be reduced. The study concludes that the application of AI could help considerably improve the management of hospital resources during global pandemics, such as COVID-19.

Consensus Recommendations for the Use of Simulation in Therapeutic Patient Education.

INTRODUCTION: Simulation is rarely used to help individuals with chronic diseases develop skills. The aim of the study was to provide recommendations for the use of simulation in therapeutic patient education (S-TPE). METHODS: Expert consensus was achieved with the participation of the following 3 groups of experts: (a) expert patients and caregivers; (b) health professionals specialized in therapeutic patient education (TPE); and (c) simulation experts. Each expert received a list of questions by e-mail in 3 iterations. The synthesis of the 2 first questionnaires resulted in 34 first recommendations voted during the consensus conference meeting. Each recommendation was subject to an extensive literature review. The quality of the evidence and the strength of the recommendations were assessed through the evaluation, development, and evaluation criteria categories (GRADE criteria). The third questionnaire selected and illustrated recommendations more specific to the use of S-TPE. RESULTS: At the end of the process, the experts identified 26 recommendations specific to the use of S-TPE. They proposed examples of skills in different diseases and stressed the importance of adapting the conditions of use (location, equipment, time of the care) to the circumstances of the patient learner and skills to be developed. Experts should exercise great caution as this technique presents ethical considerations related to patient care. CONCLUSIONS: These recommendations underline the fact that simulation could bring added value to TPE. They provide a framework and examples for the experimental use of simulation in TPE. Research into feasibility and acceptability is needed.

Moving a hospital: simulation - a way to co-produce safety healthcare facilities.

Moving a hospital is a critical period for quality and safety of healthcare. Change is very stressful for professionals. Workers who have experienced relocation of their place of work report deterioration in health status. Building a new hospital or restructuring a unit could provide an opportunity for improving safety and value in healthcare and for ensuring better quality of worklife for the staff. We used in situ simulation to promote experiential learning by training healthcare workers in the workplace in which they are expected to use their skills. In situ simulation was a way to design, plan, assess and implement a new healthcare environment before opening its doors for patient care. We can envisage that simulation will soon be used formally to identify potential problems in healthcare delivery and in staff quality of worklife in new healthcare facilities. Simulation is a way to co-produce a safe and valuable healthcare facility.

Do emergency physicians trust their patients?

The primary focus of research on the physician-patient relationship has been on patients' trust in their physicians. In this study, we explored physicians' trust in their patients. We held semi-structured interviews with expert emergency physicians concerning a patient they had just been managing. The physicians had been equipped with a head-mounted micro camera to film the encounter from an "own point of view perspective". The footage was used to stimulate recall during the interviews. Several participants made judgments on the reliability of their patients' accounts from the very beginning of the encounter. If accounts were not deemed reliable, participants implemented a variety of specific strategies in pursuing their history taking, i.e. checking for consistency by asking the same question at several points in the interview, cross-referencing information, questioning third-parties, examining the patient record, and systematically collecting data held to be objective. Our study raises the question of the influence of labeling patients as "reliable" or "unreliable" on their subsequent treatment in the emergency department. Further work is necessary to examine the accuracy of these judgments, the underlying cognitive processes (i.e. analytic versus intuitive) and their influence on decision-making.

From Context Comes Expertise: How Do Expert Emergency Physicians Use Their Know-Who to Make Decisions?

STUDY OBJECTIVE: Decisionmaking is influenced by the environment in which it takes place. The objective of our study was to explore the influence of the specific features of the emergency department (ED) environment on decisionmaking. In this paper, we specifically report on the way emergency physicians use their knowledge of their collaborators to make their decisions. METHODS: We conducted a qualitative study on emergency physicians recruited in 3 French hospitals. Physicians were equipped with a microcamera to record their clinical activity from their "own-point-of-view perspective." Semistructured interviews, based on viewing the video, were held with each physician after an actual clinical encounter with a patient. They were then analyzed thematically, using constant comparison and matrices, to identify the central themes. RESULTS: Fifteen expert emergency physicians were interviewed. Almost all of them reported using their knowledge of other health care professionals to assess the seriousness of the patient's overall condition (sometimes even before his or her arrival in the ED) to optimize the patient's treatment and to anticipate future care. CONCLUSION: Emergency physicians interact with many other health care workers during the different stages of the patient's management. The many ways in which experts use their knowledge of other health care professionals to make decisions puts traditional conceptions of expert knowledge into perspective and opens avenues for future research.

Insights into emergency physicians' minds in the seconds before and into a patient encounter.

Clinical reasoning is a core competency in medical practice. No study has explored clinical reasoning occurring before a clinical encounter, when physicians obtain preliminary information about the patient, and during the first seconds of the observation phase. This paper aims to understand what happens in emergency physicians' minds when they acquire initial information about a patient, and when they first meet a patient. The authors carried out in-depth interviews based on the video recordings of emergency situations filmed in an "own-point-of-view-perspective". 15 expert emergency physicians were interviewed between 2011 and 2012. Researchers analysed data using an interpretive approach based on thematic analysis and constant comparison. Almost all participants used a few critical pieces of information to generate hypotheses even before they actually met the patient. Pre-encounter hypotheses played a key role in the ensuing encounter by directing initial data gathering. Initial data, collected within the first few seconds of the encounter, included the patient's position on the stretcher, the way they had been prepared, their facial expression, their breathing, and their skin colour. Physicians also rapidly appraised the seriousness of the patient's overall condition, which determined their initial goals, i.e. initiating emergency treatment or pursuing the diagnostic investigation. The study brings new insights on what happens at the very beginning of the encounter between emergency physicians and patients. The results obtained from an innovative methodological approach open avenues for the development of clinical reasoning in learners.

Are schoolteachers able to teach first aid to children younger than 6 years? A comparative study.

OBJECTIVES: This study was designed to assess the knowledge acquired by very young children (<6 years) trained by their own teachers at nursery school. This comparative study assessed the effect of training before the age of 6 years compared with a group of age-matched untrained children. SETTING: Some schoolteachers were trained by emergency medical teams to perform basic first aid. PARTICIPANTS: Eighteen classes comprising 315 pupils were randomly selected: nine classes of trained pupils (cohort C1) and nine classes of untrained pupils (cohort C2). PRIMARY AND SECONDARY OUTCOME MEASURES: The test involved observing and describing three pictures and using the phone to call the medical emergency centre. Assessment of each child was based on nine criteria, and was performed by the teacher 2 months after completion of first aid training. RESULTS: This study concerned 285 pupils: 140 trained and 145 untrained. The majority of trained pupils gave the expected answers for all criteria and reacted appropriately by assessing the situation and alerting emergency services (55.7-89.3% according to the questions). Comparison of the two groups revealed a significantly greater ability of trained pupils to describe an emergency situation (p<0.005) and raise the alert (p<0.0001). CONCLUSIONS: This study shows the ability of very young children to assimilate basic skills as taught by their own schoolteachers.

Fighting violence against health workers: a way to improve quality of care?

Violence against health care workers impairs the quality of care. In one university medical center in France, 46% of the health care workers were physically assaulted at some point in the previous 12 months and 79% were verbally insulted. This article describes a participatory approach that was used to ensure health care workers take an active role in designing and implementing anti-violence measures. In each unit, a working group of health care professionals and managers developed an action plan for reducing violence-generating practices. This proactive approach is a powerful tool for motivating health care professionals to improve quality of care.

How and when do expert emergency physicians generate and evaluate diagnostic hypotheses? A qualitative study using head-mounted video cued-recall interviews.

STUDY OBJECTIVE: The ability to make a diagnosis is a crucial skill in emergency medicine. Little is known about the way emergency physicians reach a diagnosis. This study aims to identify how and when, during the initial patient examination, emergency physicians generate and evaluate diagnostic hypotheses. METHODS: We carried out a qualitative research project based on semistructured interviews with emergency physicians. The interviews concerned management of an emergency situation during routine medical practice. They were associated with viewing the video recording of emergency situations filmed in an "own-point-of-view" perspective. RESULTS: The emergency physicians generated an average of 5 diagnostic hypotheses. Most of these hypotheses were generated before meeting the patient or within the first 5 minutes of the meeting. The hypotheses were then rank ordered within the context of a verification procedure based on identifying key information. These tasks were usually accomplished without conscious effort. No hypothesis was completely confirmed or refuted until the results of investigations were available. CONCLUSION: The generation and rank ordering of diagnostic hypotheses is based on the activation of cognitive processes, enabling expert emergency physicians to process environmental information and link it to past experiences. The physicians seemed to strive to avoid the risk of error by remaining aware of the possibility of alternative hypotheses as long as they did not have the results of investigations. Understanding the diagnostic process used by emergency physicians provides interesting ideas for training residents in a specialty in which the prevalence of reasoning errors leading to incorrect diagnoses is high.

Compliance with emergency department discharge instructions.

OBJECTIVE: The purpose of this study was to assess patient understanding of ED discharge instructions. It is essential for ED patients to understand their discharge instructions. ED staff face unique challenges when providing information in a distraction-filled, limited-time setting, often with no knowledge of the patient's medical history. METHODS: A qualitative study was conducted with a sample of patients discharged from our emergency department. Data were collected via a semi-structured interview. RESULTS: A total of 36 patients participated in the study; 29 patients were discharged with a drug prescription, and complementary investigations were scheduled for 3 patients. Most patients were satisfied with the time staff spent explaining the discharge instructions. However, some patients admitted that they did not intend to fully comply with the medical prescription. Nearly half of the patients reported difficulties understanding their drug prescription (the dose or purpose of the treatment). Most patients said that their poor understanding primarily was related to lack of clarity of the written prescription. DISCUSSION: Even the most comprehensive instructions may not be clearly understood. Despite the patients' high stated levels of satisfaction with communication in the emergency department, more than half of patients failed to comply with important discharge information. Health care staff must be aware of the importance of discharge information. Further research is needed to improve the patient discharge process.