1
|
Mackenhauer J, Christensen EF, Mainz J, Valentin JB, Foss NB, Svenningsen PO, Johnsen SP. Disparities in prehospital and emergency surgical care among patients with perforated ulcers and a history of mental illness: a nationwide cohort study. Eur J Trauma Emerg Surg 2024; 50:975-985. [PMID: 38353716 PMCID: PMC11249459 DOI: 10.1007/s00068-023-02427-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/11/2023] [Indexed: 07/16/2024]
Abstract
PURPOSE To compare patients with and without a history of mental illness on process and outcome measures in relation to prehospital and emergency surgical care for patients with perforated ulcer. METHODS A nationwide registry-based cohort study of patients undergoing emergency surgery for perforated ulcer. We used data from the Danish Prehospital Database 2016-2017 and the Danish Emergency Surgery Registry 2004-2018 combined with data from other Danish databases. Patients were categorized according to severity of mental health history. RESULTS We identified 4.767 patients undergoing emergency surgery for perforated ulcer. Among patients calling the EMS with no history of mental illness, 51% were identified with abdominal pain when calling the EMS compared to 31% and 25% among patients with a history of moderate and major mental illness, respectively. Median time from hospital arrival to surgery was 6.0 h (IQR: 3.6;10.7). Adjusting for age, sex and comorbidity, patients with a history of major mental illness underwent surgery 46 min (95% CI: 4;88) later compared to patients with no history of mental illness. Median number of days-alive-and-out-of-hospital at 90-day follow-up was 67 days (IQR: 0;83). Adjusting for age, sex and comorbidity, patients with a history of major mental illness had 9 days (95% CI: 4;14) less alive and out-of-hospital at 90-day follow-up. CONCLUSION One-third of the population had a history of mental illness or vulnerability. Patients with a history of major mental illness were less likely to be identified with abdominal pain if calling the EMS prior to arrival. They had longer delays from hospital arrival to surgery and higher mortality.
Collapse
Affiliation(s)
- Julie Mackenhauer
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, 9220, Aalborg Ø, Denmark.
- Psychiatry, Aalborg University Hospital, 9000, Aalborg, North Denmark Region, Denmark.
- Department of Sociale Medicine, Aalborg University Hospital, Aalborg, Denmark.
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, 9000, Aalborg, Denmark
- Prehospital Emergency Medical Services North Denmark Region, 9000, Aalborg, Denmark
| | - Jan Mainz
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, 9220, Aalborg Ø, Denmark
- Psychiatry, Aalborg University Hospital, 9000, Aalborg, North Denmark Region, Denmark
- Department of Community Mental Health, Haifa University, Haifa, Israel
- Department of Health Economics, University of Southern Denmark, Odense, Denmark
| | - Jan Brink Valentin
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, 9220, Aalborg Ø, Denmark
| | - Nicolai Bang Foss
- Department of Anaesthesia and Intensive Care Medicine, Hvidovre Hospital, Institute for Clinical Medicine, University of Copenhagen, 2650, Hvidovre, Denmark
| | - Peter Olsen Svenningsen
- Department of Surgery, North Zealand Hospital, Copenhagen University Hospital, 3400, Hillerød, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Fredrik Bajers Vej 5, 9220, Aalborg Ø, Denmark
| |
Collapse
|
2
|
Kasvi A, Iirola T, Nordquist H. Rethinking non-urgent EMS conveyance to ED during night-time - a pilot study in Southwest Finland. BMC Emerg Med 2023; 23:95. [PMID: 37612650 PMCID: PMC10464134 DOI: 10.1186/s12873-023-00872-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 08/21/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND The amount of emergency medical service missions has increased internationally in recent years, and emergency departments are overcrowded globally. Previous evidence has shown that patients arriving at the emergency department during nighttime (20 - 08) have to wait longer, are more likely to leave without being seen, and often have non-urgent conditions compared to patients arriving during the day. The objective of this pilot study was to examine what kind of patient groups are conveyed as non-urgent to the hospital by emergency medical service during nighttime and what kind of diagnostic tests and medical interventions those patients receive before morning to identify patient groups that could be non-conveyed or directed to alternative points of care. METHODS This was a retrospective register study where the information of patients conveyed to university hospital during nighttime (20 - 08) were analyzed. Frequencies of the dispatch codes presenting complaints, medical treatments, and diagnostic tests were calculated. Age significance (under/over 70 years) was also tested. RESULTS 73.5% of the patients received neither medical treatment nor had diagnostic tests taken before morning. Most of these were patients with mental disorder(s), hip pain/complaint, or laceration/cut. Almost half of the patients with abdominal pain or fever had laboratory tests taken. Patients over 70 years old received more medications and had more diagnostic tests taken than younger patients. CONCLUSIONS Some of the low-acuity patients could be non-conveyed or referred to alternative pathways of care to avoid impolitic use of emergency medical service and to reduce the workload of emergency departments. Further research is needed to ensure patient safety for patients who are not conveyed at night.
Collapse
Affiliation(s)
- Aleksi Kasvi
- Emergency Medical Services, Turku University Hospital and University of Turku, PO Box 52, Turku, 20521, Finland
| | - Timo Iirola
- Emergency Medical Services, Turku University Hospital and University of Turku, PO Box 52, Turku, 20521, Finland
| | - Hilla Nordquist
- Department of Healthcare and Emergency Care, South-Eastern Finland University of Applied Sciences, Pääskysentie 1, Kotka, 48220, Finland.
| |
Collapse
|
3
|
Lyhne CN, Bjerrum M, Riis AH, Jørgensen MJ. Interventions to Prevent Potentially Avoidable Hospitalizations: A Mixed Methods Systematic Review. Front Public Health 2022; 10:898359. [PMID: 35899150 PMCID: PMC9309492 DOI: 10.3389/fpubh.2022.898359] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background The demand for healthcare is increasing due to an aging population, more people living with chronic diseases and medical comorbidities. To manage this demand, political institutions call for action to reduce the potentially avoidable hospitalizations. Quantitative and qualitative aspects should be considered to understand how and why interventions work, and for whom. The aim of this mixed methods systematic review was to identify and synthesize evidence on interventions targeting avoidable hospitalizations from the perspectives of the citizens and the healthcare professionals to improve the preventive healthcare services. Methods and Results A mixed methods systematic review was conducted following the JBI methodology using a convergent integrated approach to synthesis. The review protocol was registered in PROSPERO, reg. no. CRD42020134652. A systematic search was undertaken in six databases. In total, 45 articles matched the eligibility criteria, and 25 of these (five qualitative studies and 20 quantitative studies) were found to be of acceptable methodological quality. From the 25 articles, 99 meaning units were extracted. The combined evidence revealed four categories, which were synthesized into two integrated findings: (1) Addressing individual needs through care continuity and coordination prevent avoidable hospitalizations and (2) Recognizing preventive care as an integrated part of the healthcare work to prevent avoidable hospitalizations. Conclusions The syntheses highlight the importance of addressing individual needs through continuous and coordinated care practices to prevent avoidable hospitalizations. Engaging healthcare professionals in preventive care work and considering implications for patient safety may be given higher priority. Healthcare administers and policy-makers could support the delivery of preventive care through targeted educational material aimed at healthcare professionals and simple web-based IT platforms for information-sharing across healthcare settings. The findings are an important resource in the development and implementation of interventions to prevent avoidable hospitalizations, and may serve to improve patient safety and quality in preventive healthcare services. Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=134652, identifier: CRD42020134652.
Collapse
Affiliation(s)
- Cecilie Nørby Lyhne
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Research, Horsens Regional Hospital, Horsens, Denmark
- *Correspondence: Cecilie Nørby Lyhne
| | - Merete Bjerrum
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Centre for Clinical Guidelines and Danish Centre of Systematic Reviews, A JBI Centre of Excellence, Aalborg University, Aalborg, Denmark
| | - Anders Hammerich Riis
- Department of Research, Horsens Regional Hospital, Horsens, Denmark
- Enversion A/S, Aarhus, Denmark
| | | |
Collapse
|
4
|
Lyhne CN, Bjerrum M, Jørgensen MJ. Person-centred care to prevent hospitalisations - a focus group study addressing the views of healthcare providers. BMC Health Serv Res 2022; 22:801. [PMID: 35725608 PMCID: PMC9210672 DOI: 10.1186/s12913-022-08198-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background The primary healthcare sector comprises various health services, including disease prevention at local level. Research shows that targeted primary healthcare services can prevent the development of acute complications and ultimately reduce the risk of hospitalisations. While interdisciplinary collaboration has been suggested as a means to improve the quality and responsiveness of personal care needs in preventive services, effective implementation remains a challenge. To improve the quality and responsiveness of primary healthcare and to develop initiatives to support the interdisciplinary collaboration in preventive services, there is a need to investigate the views of primary healthcare providers. The aim of this study was to investigate perceptions of preventive care among primary healthcare providers by examining their views on what constitutes a need for hospitalisation, and which strategies are found useful to prevent hospitalisation. Further, to explain how interdisciplinary collaboration can be supported with a view to providing person-centred care. Methods Five focus group interviews were conducted with 27 healthcare providers, including general practitioners, social and healthcare assistants, occupational therapists, physiotherapists, home care nurses, specialist nurses and acute care nurses. Interviews were transcribed, and analysed with qualitative content analysis. Results Three categories emerged from the analysis: 1) Mental and social conditions influence physical functioning and hospitalisation need, 2) Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration and 3) Interdisciplinary collaboration in primary healthcare services is predominantly focussed on handling acute physical conditions. These describe that the healthcare providers are attentive towards the influence of mental, social and physical conditions on the risk of hospitalisation, entailing a focus on person-centred care. Nevertheless, in the preventive services, interdisciplinary collaboration focusses primarily on handling acute physical conditions, which constitutes a barrier for interdisciplinary collaboration. Conclusions By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately to prevent some hospitalisations. Stakeholders at all levels should be informed about the relevance of considering mental, social and physical conditions to improve the quality and responsiveness of primary healthcare services and to develop initiatives to support interdisciplinary collaboration. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08198-6.
Collapse
Affiliation(s)
- Cecilie Nørby Lyhne
- Research Unit for Nursing and Healthcare, Department of Public Health, Aarhus University, Bartholins Allé 2, 3, 8000, Aarhus C, Denmark. .,Research Unit, Horsens Regional Hospital, Central Denmark Region, Sundvej 30X, 8700, Horsens, Denmark.
| | - Merete Bjerrum
- Research Unit for Nursing and Healthcare, Department of Public Health, Aarhus University, Bartholins Allé 2, 3, 8000, Aarhus C, Denmark.,Center for Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Soendre Skovvej 15, 9000, Aalborg, Denmark
| | | |
Collapse
|
5
|
Önnheim S, Johansson A, Ivarsson B, Hagström C. Self-Perceived Competence of Ambulance Nurses in the Care of Patients with Mental Illness: A Questionnaire Survey. NURSING REPORTS 2022; 12:226-234. [PMID: 35324569 PMCID: PMC8954289 DOI: 10.3390/nursrep12010023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/16/2022] Open
Abstract
Ambulance nurses in prehospital emergency care must assess, treat, and triage patients with mental health issues. This study aimed to investigate the self-perceived competence of ambulance nurses in prehospital emergency care of patients with mental illness. A cross-sectional questionnaire survey was done, a question-index value (Q-IV; range: 0–1.0) was defined as a summary of the proportion of positive responses (%). Correlations of self-perceived competence with education and professional experience were also examined. Overall self-perceived competence was good (mean Q-IV, 0.80). For six of the nine questions, women rated their abilities slightly lower than men. Women rated themselves as fairly good in providing “information about types of effective help available” (Q-IV, 0.55) and in “suggesting tactics for helping a person with mental illness feel better” (Q-IV, 0.56). Men rated their competence as fairly good in “directing patients to appropriate sources of help” (Q-IV, 0.58). Self-perceived competence did not correlate with education level or professional experience. In conclusion, these results indicate that in encounters with patients who have mental illness, ambulance nurses perceive their overall competencies as good, with some sex-based differences in self-perception for specific knowledge areas. Education level and professional experience did not correlate with self-perceived competence.
Collapse
Affiliation(s)
- Sandra Önnheim
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
| | - Anders Johansson
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
- Department of Clinical Sciences, Lund University, P.O. Box 117, 22185 Lund, Sweden
| | - Bodil Ivarsson
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
- Department of Clinical Sciences, Lund University, P.O. Box 117, 22185 Lund, Sweden
- Correspondence: ; Tel.: +46-768-870-467
| | - Caroline Hagström
- Office of Medical Services, Region Skane, Kioskgatan 17, 22185 Lund, Sweden; (S.Ö.); (A.J.); (C.H.)
| |
Collapse
|