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Shagerdi G, Ayatollahi H, Hemmat M, Zeraatkar K. The application of health information technology for the elderly care in the emergency department: a conceptual model. BMC Geriatr 2024; 24:618. [PMID: 39030512 PMCID: PMC11264990 DOI: 10.1186/s12877-024-05212-w] [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: 03/14/2024] [Accepted: 07/09/2024] [Indexed: 07/21/2024] Open
Abstract
INTRODUCTION In the emergency departments (EDs), usually the longest waiting time for treatment and discharge belongs to the elderly patients. Moreover, the number of the ED admissions for the elderly increases every year. It seems that the use of health information technology in geriatric emergency departments can help to reduce the burden of the healthcare services for this group of patients. This research aimed to develop a conceptual model for using health information technology in the geriatric emergency department. METHODS This study was conducted in 2021. The initial conceptual model was designed based on the findings derived from the previous research phases (literature review and interview with the experts). Then, the model was examined by an expert panel (n = 7). Finally, using the Delphi technique (two rounds), the components of the conceptual model were reviewed and finalized. To collect data, a questionnaire was used, and data were analyzed using descriptive statistics. RESULTS The common information technologies appropriate for the elderly care in the emergency departments included emergency department information system, clinical decision support system, electronic health records, telemedicine, personal health records, electronic questionnaires for screening, and other technologies such as picture archiving and communication systems (PACS), electronic vital sign monitoring systems, etc. The participants approved all of the proposed systems and their applications in the geriatric emergency departments. CONCLUSION The proposed model can help to design and implement the most useful information systems in the geriatric emergency departments. As the application of technology accelerates care processes, investing in this field would help to support the care plans for the elderly and improve quality of care services. Further research is recommended to investigate the efficiency and effectiveness of using these technologies in the EDs.
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Affiliation(s)
- Ghazal Shagerdi
- Department of Health Information Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Haleh Ayatollahi
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran.
| | - Morteza Hemmat
- Department of Health Information Technology, Saveh University of Medical Sciences, Saveh, Iran
| | - Kimia Zeraatkar
- Education Development Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
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Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective. J Multidiscip Healthc 2024; 17:1385-1400. [PMID: 38560485 PMCID: PMC10981423 DOI: 10.2147/jmdh.s460194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.
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Affiliation(s)
- Maria Strandås
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jaana Sepp
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Ljudmila Linnik
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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3
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Forsgärde ES, Rööst M, Svensson A, Fridlund B, Elmqvist C. Support in acute situations when a community health nurse is called: experiences of older patients, their significant others, and involved healthcare professionals- a qualitative interview study. BMC Geriatr 2023; 23:608. [PMID: 37770856 PMCID: PMC10537128 DOI: 10.1186/s12877-023-04331-0] [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: 06/30/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Care decisions for older patients in acute situations are challenging to make, and there is limited knowledge of support in home healthcare settings, where older patients receive ongoing health care from, for example, community health nurses. Therefore, this study aimed to describe the support for all involved in acute situations when a community health nurse was called, as experienced by older patients, their significant others and healthcare professionals involved. METHODS The study was conducted using a phenomenological reflective lifeworld research approach, in which meanings of the study phenomenon were analyzed. The included participants were those who had been involved in acute situations. Twelve participants from four acute situations were interviewed. The participant included three older patients, one significant other, four community health nurses, one registered nurse student, one specialist in general practice, and two ambulance personnel, with one being a registered nurse and the other a specialist ambulance nurse. RESULTS Support in decision-making was received from the knowledge of temporality, which provided a comprehensive understanding based on past and present knowledge of the older patient. The knowledge of temporality allowed for the early detection of new symptoms and facilitated care decisions tailored to the older patient. There was a dependency on pre-existing mutual interpersonal support, and confidence developed through relational, caring, and medical competence. CONCLUSIONS The advantages of temporality, confidence and mutual interpersonal support in acute situations highlight the importance of enhancing relational continuity in home healthcare settings and establishing a structural collaboration among community health nurses, specialists in general practice, and ambulance personnel. This collaboration aims to provide support for making decisions regarding tailored care.
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Affiliation(s)
- Elin-Sofie Forsgärde
- Department of Health and Caring Sciences, Linnaeus University, PO Box 451, Växjö, 351 95, Sweden.
- Center of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, 351 95, Sweden.
| | - Mattias Rööst
- Department for Research and Development, Region Kronoberg, PO Box 1223, Växjö, 351 12, Sweden
- Department of Clinical Sciences in Malmö, Family Medicine, Lund University, PO Box 50332, Malmö, 202 13, Sweden
| | - Anders Svensson
- Department of Health and Caring Sciences, Linnaeus University, PO Box 451, Växjö, 351 95, Sweden
- Center of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, 351 95, Sweden
- Ambulance Service, Region Kronoberg, PO Box 1207, Växjö, 352 54, Sweden
| | - Bengt Fridlund
- Center of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, 351 95, Sweden
| | - Carina Elmqvist
- Department of Health and Caring Sciences, Linnaeus University, PO Box 451, Växjö, 351 95, Sweden
- Center of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, 351 95, Sweden
- Department for Research and Development, Region Kronoberg, PO Box 1223, Växjö, 351 12, Sweden
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Jomard N, Vincent A, Chammem R, Gilbert T, Rouze H, Comte B, Haesebaert J, Schott AM. Emergency calls concerning older patients: Are the appropriate questions asked? Geriatr Gerontol Int 2023; 23:54-59. [PMID: 36461775 DOI: 10.1111/ggi.14509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 10/10/2022] [Accepted: 10/17/2022] [Indexed: 12/04/2022]
Abstract
AIM In the present study, we evaluated the triage process particularly for older patients after calls to Emergency Medical Call Centers (ECC), according to the geriatric assessment tool. METHODS In this observational population-based cross-sectional study in the Rhône (France), we analyzed the audiotapes of all calls received by ECC concerning patients aged ≥75 years, during seven randomly selected days, over a period of 1 year. We analyzed whether information about seven key items, predefined by a panel of experts as essential for quality telephone triage of seniors, was actually collected. RESULTS Among 4168 calls, 712 (17.1%) concerned patients >75 years (mean ± SD, age 84.6 ± 5.6 years). The mean duration of calls was 3 min 28 s. Information about living arrangements (alone or not), dependency, multiple pathologies, polymedication, ability to walk independently or with help, and hospitalization in the previous 3 months was not collected in 20%, 42%, 40%, 45%, 58% and 61% of calls, respectively. All seven geriatric items were collected for only 54 (7.8%) calls, and only three criteria collected for 277 (40%) calls. Nurse-managed calls were significantly associated with the collection of less geriatric items compared with physician-managed calls. CONCLUSION Key information is particularly important to guide the orientation, and further management of older patients may be lacking during the telephone triage of patients in ECCs. This may represent an important level of improvement of the triage process, to address the needs of older patients better and avoid inappropriate emergency department visits. Geriatr Gerontol Int 2023; 23: 54-59.
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Affiliation(s)
- Nathalie Jomard
- Hospices Civils de Lyon, Hôpital des Charpennes, Geriatric Medical Team, Lyon, France
| | - Adélaïde Vincent
- Hospices Civils de Lyon, Hôpital E. Herriot, Acute Medical Geriatric Unit, Lyon, France
| | - Rita Chammem
- Université Claude Bernard Lyon 1, Laboratoire HESPER, Lyon, France
| | - Thomas Gilbert
- Université Claude Bernard Lyon 1, Laboratoire HESPER, Lyon, France.,Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Geriatric Deparment, Lyon, France
| | - Heloïse Rouze
- Université Claude Bernard Lyon 1, Laboratoire HESPER, Lyon, France.,Hospices Civils de Lyon, Pôle de santé publique, Lyon, France
| | - Brigitte Comte
- Hospices Civils de Lyon, Hôpital E. Herriot, Short Stay Geriatric Unit, Lyon, France
| | - Julie Haesebaert
- Université Claude Bernard Lyon 1, Laboratoire HESPER, Lyon, France.,Hospices Civils de Lyon, Pôle de santé publique, Lyon, France
| | - Anne-Marie Schott
- Université Claude Bernard Lyon 1, Laboratoire HESPER, Lyon, France.,Hospices Civils de Lyon, Pôle de santé publique, Lyon, France
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Shagerdi G, Ayatollahi H, Hemmat M. Emergency care for the elderly: A review of the application of health information technology. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Wennman I, Carlström E, Fridlund B, Wijk H. Experienced critical incidents affecting lead-times in the stroke care chain for low-priority patients - A qualitative study with critical incident technique. Int Emerg Nurs 2021; 58:101040. [PMID: 34329825 DOI: 10.1016/j.ienj.2021.101040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 04/30/2021] [Accepted: 06/05/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The time elapsing from the alarm being raised to arrival at the stroke unit is crucial for patients suffering a conceivable stroke. More knowledge is needed about critical incidents-both favourable and unfavourable-affecting the lead time in the care chain. AIM To explore favourable and unfavourable critical incidents (CIs), affecting lead times in the care chain from the alerted ambulance to the stroke unit, as experienced by nurses, for low-priority patients suffering a conceivable acute stroke. METHOD The study had an explorative descriptive design using a qualitative approach of Flanagan's Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care chain at a hospital in western Sweden were interviewed about their experiences regarding CIs influencing the lead time for low-priority patients. RESULTS There were 363 CIs identified related to human interactions and organizational structures. The types of CIs varied depending on where in the care chain they were experienced. Both favourable and unfavourable factors had an impact on the length of the lead time from alerted ambulance to stroke unit for lowpriority patients. Furthermore, CIs occurring both early and later in the care chain affected the whole process. CONCLUSIONS There is a need for greater understanding within each interrelated department in the care chain about how CIs at one part of the care chain have an impact on another.
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Affiliation(s)
- Ingela Wennman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden; Gothenburg Emergency Medicine Research Group, Sahlgrenska University Hospital, Sweden.
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden; Gothenburg Emergency Medicine Research Group, Sahlgrenska University Hospital, Sweden; Department of Business, History, and Social Sciences, School of Business, University of South-Eastern Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway; Centre for Inter-Professional Collaboration within Emergency Care, Linnaeus University, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden; Sahlgrenska Universitetssjukhuset, Gothenburg, Sweden; Chalmers University of Technology, Gothenburg, Sweden
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Alternatives to direct emergency department conveyance of ambulance patients: a scoping review of the evidence. Scand J Trauma Resusc Emerg Med 2021; 29:4. [PMID: 33407771 PMCID: PMC7789540 DOI: 10.1186/s13049-020-00821-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/02/2020] [Indexed: 12/02/2022] Open
Abstract
Background The role of ambulance services is shifting, due in part to more intermediate, non-urgent patients who do not require direct emergency department conveyance, yet who cannot be safely left at home alone. Evidence surrounding the safety, effectiveness and efficiency of alternate care routes is not well known. Methods This scoping review sought to identify all studies that examined alternate routes of care for the non-urgent “intermediate” patient, as triaged on scene. Search terms for the sample (ambulances, paramedics, etc.) and intervention (e.g. referrals, alternate care route, non-conveyance) were combined. Articles were systematically searched using four databases and grey literature sources (February 2020). Independent researchers screened title-abstract and full text stages. Results Of 16,037 records, 41 examined alternate routes of care after triage by the on-scene paramedic. Eighteen articles considered quantitative patient data, 12 studies provided qualitative perspectives while 11 were consensus or opinion-based articles. The benefits of alternative schemes are well-recognised by patients, paramedics and stakeholders and there is supporting evidence for a positive impact on patient-centered care and operational efficiency. Challenges to successful use of schemes included: patient safety resulting from incorrect triage decisions, inadequate training, lack of formal partnerships between ambulance and supporting services, and insufficient evidence to support safe implementation or continued use. Studies often inaccurately defined success using proxies for patient safety (e.g. decision comparisons, rates of secondary contact). Finally, patients expressed willingness for such schemes but their preference must be better understood. Conclusions This broad summary offers initial support for alternate routes of care for intermediate, non-urgent patients. Even so, most studies lacked methodologically rigorous evidence and failed to evaluate safe patient outcomes. Some remedies appear to be available such as formal triage pathways, targeted training and organisational support, however there is an urgent need for more research and dissemination in this area.
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Varg S, Vicente V, Castren M, Lindgren P, Rehnberg C. Healthcare pathways and resource use: mapping consequences of ambulance assessment for direct care with alternative healthcare providers. BMC Emerg Med 2020; 20:85. [PMID: 33126854 PMCID: PMC7602326 DOI: 10.1186/s12873-020-00380-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 10/16/2020] [Indexed: 11/10/2022] Open
Abstract
Background A decision system in the ambulance allowing alternative pathways to alternate healthcare providers has been developed for older patients in Stockholm, Sweden. However, subsequent healthcare resource use resulting from these pathways has not yet been addressed. The aim of this study was therefore to describe patient pathways, healthcare utilisation and costs following ambulance transportation to alternative healthcare providers. Methods The design of this study was descriptive and observational. Data from a previous RCT, where a decision system in the ambulance enabled alternative healthcare pathways to alternate healthcare providers were linked to register data. The receiving providers were: primary acute care centre or secondary geriatric ward, both located at the same community hospital, or the conventional pathway to the emergency department at an acute hospital. Resource use over 10 days, subsequent to assessment with the decision system, was mapped in terms of healthcare pathways, utilisation and costs for the 98 included cases. Results Almost 90% were transported to the acute care centre or geriatric ward. The vast majority arriving to the geriatric ward stayed there until the end of follow-up or until discharged, whereas patients conveyed to the acute care centre to a large extent were admitted to hospital. The median patient had 6 hospital days, 2 outpatient visits and costed roughly 4000 euros over the 10-day period. Arrival destination geriatric ward indicated the longest hospital stay and the emergency department the shortest. However, the cost for the 10-day period was lower for cases arriving to the geriatric ward than for those arriving to the emergency department. Conclusions The findings support the appropriateness of admittance directly to secondary geriatric care for older adults. However, patients conveyed to the acute care centre ought to be studied in more detail with regards to appropriate level of care.
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Affiliation(s)
- Sofi Varg
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden. .,Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden.
| | - Veronica Vicente
- Ambulance Medical Service in Stockholm [Ambulanssjukvården i Storstockholm AB], Stockholm, Sweden.,Academic Emergency Medical Services, Stockholm, Sweden.,Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - Maaret Castren
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden.,Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Peter Lindgren
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.,The Swedish Institute for Health Economics, Lund, Sweden
| | - Clas Rehnberg
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden.,Centre for Health Economics, Informatics and Health Services Research, Stockholm Health Care Services, Stockholm, Sweden
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Bashiri A, Alizadeh Savareh B, Ghazisaeedi M. Promotion of prehospital emergency care through clinical decision support systems: opportunities and challenges. Clin Exp Emerg Med 2019; 6:288-296. [PMID: 31910499 PMCID: PMC6952626 DOI: 10.15441/ceem.18.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 10/12/2018] [Indexed: 11/23/2022] Open
Abstract
Clinical decision support systems are interactive computer systems for situational decision making and can improve decision efficiency and safety of care. We investigated the role of these systems in enhancing prehospital care. This narrative review included full-text articles published since 2000 that were available in databases/e-journals including Web of Science, PubMed, Science Direct, and Google Scholar. Search keywords included "clinical decision support system," "decision support system," "decision support tools," "prehospital care," and "emergency medical services." Non-journal articles were excluded. We revealed 14 relevant studies that used such a support system in prehospital emergency medical service. Owing to the dynamic nature of emergency situations, decision timing is critical. Four key factors demonstrated the ability of clinical decision support systems to improve decision-making, reduce errors, and improve the safety of prehospital emergency activity: computer-based, offer support as a natural part of the workflow, provide decision support in the time and place of decision making, and offer practical advice. The use of clinical decision support systems in prehospital care resulted in accurate diagnoses, improved patient triage and patient outcomes, and reduction of prehospital time. By improving emergency management and rescue operations, the quality of prehospital care will be enhanced.
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Affiliation(s)
- Azadeh Bashiri
- Department of Health Information Management, School of Management and Medical Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Behrouz Alizadeh Savareh
- Department of Medical Informatics, School of Management & Medical Education Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Marjan Ghazisaeedi
- Department of Health Information Management, School of Allied-Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
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Lederman J, Löfvenmark C, Djärv T, Lindström V, Elmqvist C. Assessing non-conveyed patients in the ambulance service: a phenomenological interview study with Swedish ambulance clinicians. BMJ Open 2019; 9:e030203. [PMID: 31551383 PMCID: PMC6773311 DOI: 10.1136/bmjopen-2019-030203] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To combat overcrowding in emergency departments, ambulance clinicians (ACs) are being encouraged to make on-site assessments regarding patients' need for conveyance to hospital, and this is creating new and challenging demands for ACs. This study aimed to describe ACs' experiences of assessing non-conveyed patients. DESIGN A phenomenological interview study based on a reflective lifeworld research approach. SETTING The target area for the study was Stockholm, Sweden, which has a population of approximately 2.3 million inhabitants. In this area, 73 ambulances perform approximately just over 200 000 ambulance assignments annually, and approximately 25 000 patients are non-conveyed each year. INFORMANTS 11 ACs. METHODS In-depth open-ended interviews. RESULTS ACs experience uncertainty regarding the accuracy of their assessments of non-conveyed patients. In particular, they fear conducting erroneous assessments that could harm patients. Avoiding hasty decisions is important for conducting safe patient assessments. Several challenging paradoxes were identified that complicate the non-conveyance situation, namely; responsibility, education and feedback paradoxes. The core of the responsibility paradox is that the increased responsibility associated with non-conveyance assessments is not accompanied with appropriate organisational support. Thus, frustration is experienced. The education paradox involves limited and inadequate non-conveyance education. This, in combination with limited support from non-conveyance guidelines, causes the clinical reality to be perceived as challenging and problematic. Finally, the feedback paradox relates to the obstruction of professional development as a result of an absence of learning possibilities after assessments. Additionally, ACs also described loneliness during non-conveyance situations. CONCLUSIONS This study suggests that, for ACs, performing non-conveyance assessments means experiencing a paradoxical professional existence. Despite these aggravating paradoxes, however, complex non-conveyance assessments continue to be performed and accompanied with limited organisational support. To create more favourable circumstances and, hopefully, safer assessments, further studies that focus on these paradoxes and non-conveyance are needed.
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Affiliation(s)
- Jakob Lederman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Academic Emergency Medical Service, Region Stockholm, Stockholm, Sweden
| | - Caroline Löfvenmark
- Division of Cardiovascular Medicine, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
- Sophiahemmet University College, Stockholm, Sweden
| | - Therese Djärv
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Veronica Lindström
- Academic Emergency Medical Service, Region Stockholm, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Section of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Carina Elmqvist
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre of Interprofessional Cooperation within Emergency care (CICE), Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
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Karlsson S, Ridbäck A, Brobeck E, Norell Pejner M. Health Promotion Practices in Nursing for Elderly Persons in Municipal Home Care: An Integrative Literature Review. HOME HEALTH CARE MANAGEMENT AND PRACTICE 2019. [DOI: 10.1177/1084822319863308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Elderly patients sometimes seek emergency services unnecessarily. Emergency clinics can be detrimental to the elderly. The purpose of this study was to find health promotion practices that enable a registered nurse in community health to reduce the need for home care clients to seek emergency care. The method of integrative literature review was used. Through health promotion work in the home, the registered nurses in community health (in conjunction with other professionals) can strengthen patients’ self-esteem and reduce their emergency care visits. Patient involvement is part of this work, and the registered nurses in community health needs to get to know patients to learn their health needs, design individual care plans, and find out whether they need education about their own health and/or health care services available to them. Registered nurses in community health experience difficulties in performing health promotion because they perceive that other tasks have higher priority.
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Heekin AM, Kontor J, Sax HC, Keller MS, Wellington A, Weingarten S. Choosing Wisely clinical decision support adherence and associated inpatient outcomes. THE AMERICAN JOURNAL OF MANAGED CARE 2018; 24:361-366. [PMID: 30130028 PMCID: PMC6813785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To determine whether utilization of clinical decision support (CDS) is correlated with improved patient clinical and financial outcomes. STUDY DESIGN Observational study of 26,424 patient encounters. In the treatment group, the provider adhered to all CDS recommendations. In the control group, the provider did not adhere to CDS recommendations. METHODS An observational study of provider adherence to a CDS system was conducted using inpatient encounters spanning 3 years. Data comprised alert status (adherence), provider type (resident, attending), patient demographics, clinical outcomes, Medicare status, and diagnosis information. We assessed the associations between alert adherence and 4 outcome measures: encounter length of stay, odds of 30-day readmission, odds of complications of care, and total direct costs. The associations between alert adherence and the outcome measures were estimated using 4 generalized linear models that adjusted for potential confounders, such as illness severity and case complexity. RESULTS The total encounter cost increased 7.3% (95% CI, 3.5%-11%) for nonadherent encounters versus adherent encounters. We found a 6.2% (95% CI, 3.0%-9.4%) increase in length of stay for nonadherent versus adherent encounters. The odds ratio for readmission within 30 days increased by 1.14 (95% CI, 0.998-1.31) for nonadherent versus adherent encounters. The odds ratio for complications increased by 1.29 (95% CI, 1.04-1.61) for nonadherent versus adherent encounters. CONCLUSIONS Consistent improvements in measured outcomes were seen in the treatment group versus the control group. We recommend that provider organizations consider the introduction of real-time CDS to support adherence to evidence-based guidelines, but because we cannot determine the cause of the associations between CDS interventions and improved clinical and financial outcomes, further study is required.
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Johansson N, Spindler C, Valik J, Vicente V. Developing a decision support system for patients with severe infection conditions in pre-hospital care. Int J Infect Dis 2018; 72:40-48. [PMID: 29753877 DOI: 10.1016/j.ijid.2018.04.4321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 04/22/2018] [Accepted: 04/26/2018] [Indexed: 10/16/2022] Open
Abstract
OBJECTIVE To develop and validate a pre-hospital decision support system (DSS) for the emergency medical services (EMS), enabling the identification and steering of patients with critical infectious conditions (i.e., severe respiratory tract infections, severe central nervous system (CNS) infections, and sepsis) to a specialized emergency department (ED) for infectious diseases. METHODS The development process involved four consecutive steps. The first step was gathering data from the electronic patient care record system (ePCR) on patients transported by the EMS, in order to identify retrospectively appropriate patient categories for steering. The second step was to let a group of medical experts give advice and suggestions for further development of the DSS. The third and fourth steps were the evaluation and validation, respectively, of the whole pre-hospital DSS in a pilot study. RESULTS A pre-hospital decision support tool (DST) was developed for three medical conditions: severe respiratory infection, severe CNS infection, and sepsis. The pilot study included 72 patients, of whom 60% were triaged to a highly specialized emergency department (ED-Spec) with an attending infectious disease physician (ID physician). The results demonstrated that the pre-hospital emergency nurses (PENs) adhered to the DST in 66 of 72 patient cases (91.6%). For those patients steered to the ED-Spec, the assessment made by PENs and the ID physician at the ED was concordant in 94% of cases. CONCLUSIONS The development of a specific DSS aiming to identify patients with three different severe infectious diseases appears to give accurate decision support to PENs when steering patients to the optimal level of care.
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Affiliation(s)
- Niclas Johansson
- Karolinska Institutet, Department of Medicine, Solna, Infectious Diseases Unit, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Carl Spindler
- Karolinska Institutet, Department of Medicine, Solna, Infectious Diseases Unit, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - John Valik
- Karolinska Institutet, Department of Medicine, Solna, Infectious Diseases Unit, Karolinska University Hospital, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Veronica Vicente
- Karolinska Institutet, Department of Clinical Science and Education and Section of Emergency Medicine, Södersjukhuset and Academic EMS, Stockholm, Sweden; Ambulanssjukvården i Storstockholm (AISAB, Ambulance Medical Service in Stockholm), Sweden.
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Abstract
Objectives No general emergency department triage scale has been evaluated for prehospital triage. The objective of this study was to evaluate the reliability and the performance of the Swiss Emergency Triage Scale (SETS) used by paramedics to determine the emergency level and orientation of simulated patients. Patients and methods In a prospective cross-sectional study, 23 paramedics evaluated 28 clinical scenarios with the SETS using interactive computerized triage software simulating real-life triage. The primary outcome was inter-rater reliability regarding the triage level among participants measured by intraclass correlation coefficient (ICC). Secondary outcomes were the accuracy of triage level and the reliability and accuracy of orientation of patients of at least 75 years to a dedicated geriatric emergency centre. Results Twenty-three paramedics completed the evaluation of the 28 scenarios (644 triage decisions). Overall, ICC for triage level was 0.84 (95% confidence interval: 0.77–0.99). Correct emergency level was assigned in 89% of cases, overtriage rate was 4.8%, and undertriage was 6.2%. ICC regarding orientation in the subgroup of simulated patients of at least 75 years was 0.76 (95% confidence interval: 0.61–0.89), with 93% correct orientation. Conclusion Reliability of paramedics rating simulated emergency situations using the SETS was excellent, and the accuracy of their rating was very high. This suggests that in Switzerland, the SETS could be safely used in the prehospital setting by paramedics to determine the level of emergency and guide patients to the most appropriate hospital.
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Norberg Boysen G, Nyström M, Christensson L, Herlitz J, Wireklint Sundström B. Trust in the early chain of healthcare: lifeworld hermeneutics from the patient's perspective. Int J Qual Stud Health Well-being 2017; 12:1356674. [PMID: 28793852 PMCID: PMC5590623 DOI: 10.1080/17482631.2017.1356674] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2017] [Indexed: 11/03/2022] Open
Abstract
PURPOSE Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for a non-urgent condition and been referred to the healthcare centre. METHOD A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patients participated: seven female and three male. The setting is the early chain of healthcare in south-western Sweden. RESULTS The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient's lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the "voice of the lifeworld" enables the patient to feel trust. CONCLUSION Trust in the early chain of healthcare entails caregivers' ability to pay attention to both medical and existential issues in compliance with the patient's information and questions. Thus, the patient must be invited to participate in assessments and decisions concerning his or her own healthcare, in a credible manner and using everyday language.
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Affiliation(s)
- Gabriella Norberg Boysen
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, PreHospen – Centre for Prehospital Research, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Maria Nyström
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Lennart Christensson
- Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Johan Herlitz
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, PreHospen – Centre for Prehospital Research, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Birgitta Wireklint Sundström
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, PreHospen – Centre for Prehospital Research, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Huntley AL, Chalder M, Shaw ARG, Hollingworth W, Metcalfe C, Benger JR, Purdy S. A systematic review to identify and assess the effectiveness of alternatives for people over the age of 65 who are at risk of potentially avoidable hospital admission. BMJ Open 2017; 7:e016236. [PMID: 28765132 PMCID: PMC5642761 DOI: 10.1136/bmjopen-2017-016236] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/OBJECTIVES There are some older patients who are 'at the decision margin' of admission. This systematic review sought to explore this issue with the following objective: what admission alternatives are there for older patients and are they safe, effective and cost-effective? A secondary objective was to identify the characteristics of those older patients for whom the decision to admit to hospital may be unclear. DESIGN Systematic review of controlled studies (April 2005-December 2016) with searches in Medline, Embase, Cinahl and CENTRAL databases. The protocol is registered at PROSPERO (CRD42015020371). Studies were assessed using Cochrane risk of bias criteria, and relevant reviews were assessed with the AMSTAR tool. The results are presented narratively and discussed. SETTING Primary and secondary healthcare interface. PARTICIPANTS People aged over 65 years at risk of an unplanned admission. INTERVENTIONS Any community-based intervention offered as an alternative to admission to an acute hospital. PRIMARY AND SECONDARY OUTCOMES MEASURES Reduction in secondary care use, patient-related outcomes, safety and costs. RESULTS Nineteen studies and seven systematic reviews were identified. These recruited patients with both specific conditions and mixed chronic and acute conditions. The interventions involved paramedic/emergency care practitioners (n=3), emergency department-based interventions (n=3), community hospitals (n=2) and hospital-at-home services (n=11). Data suggest that alternatives to admission appear safe with potential to reduce secondary care use and length of time receiving care. There is a lack of patient-related outcomes and cost data. The important features of older patients for whom the decision to admit is uncertain are: age over 75 years, comorbidities/multi-morbidities, dementia, home situation, social support and individual coping abilities. CONCLUSIONS This systematic review describes and assesses evidence on alternatives to acute care for older patients and shows that many of the options available are safe and appear to reduce resource use. However, cost analyses and patient preference data are lacking.
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Affiliation(s)
- Alyson L Huntley
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Melanie Chalder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Brunelcare, Saffron Gardens, Bristol, UK
| | - Ali R G Shaw
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - William Hollingworth
- Health Economics at Bristol, School of Social and Community Medicine University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, University of Bristol, Bristol, UK
| | - Jonathan Richard Benger
- Faculty of Health and Applied Sciences, University of the West of England, Bristol, UK
- Department of Emergency Medicine, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Sarah Purdy
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, Bristol, UK
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Pre-hospital assessment by a single responder: The Swedish ambulance nurse in a new role: A pilot study. Int Emerg Nurs 2016; 26:32-7. [DOI: 10.1016/j.ienj.2015.09.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 08/30/2015] [Accepted: 09/01/2015] [Indexed: 11/23/2022]
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Larsson G, Strömberg RU, Rogmark C, Nilsdotter A. Prehospital fast track care for patients with hip fracture: Impact on time to surgery, hospital stay, post-operative complications and mortality a randomised, controlled trial. Injury 2016; 47:881-6. [PMID: 26895715 DOI: 10.1016/j.injury.2016.01.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 01/17/2016] [Accepted: 01/31/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Ambulance organisations in Sweden have introduced prehospital fast track care (PFTC) for patients with suspected hip fracture. This means that the ambulance nurse starts the pre-operative procedure otherwise implemented at the accident & emergency ward (A&E) and transports the patient directly to the radiology department instead of A&E. If the diagnosis is confirmed, the patient is transported directly to the orthopaedic ward. No previous randomised, controlled studies have analysed PFTC to describe its possible advantages. The aim of this study is to examine whether PFTC has any impact on outcomes such as time to surgery, length of stay, post-operative complications and mortality. METHODS The design of this study is a prehospital randomised, controlled study, powered to include 400 patients. The patients were randomised into PFTC or the traditional care pathway (A&E group). RESULTS Time from arrival to start for X-ray was faster for PFTC (mean, 28 vs. 145 min; p<0.001), but the groups did not differ with regard to time from start of X-ray to start of surgery (mean 18.40 h in both groups). No significant differences between the groups were observed with regard to: time from arrival to start of surgery (p=0.07); proportion operated within 24h (79% PFTC, 75% A&E; p=0.34); length of stay (p=0.34); post-operative complications (p=0.75); and 4 month mortality (18% PFTC, 15% A&E p=0.58). CONCLUSION PFTC improved time to X-ray and admission to a ward, as expected, but did not significantly affect time to start of surgery, length of stay, post-operative complications or mortality. These outcomes were probably affected by other factors at the hospital. Patients with either possible life-threatening conditions or life-threatening conditions prehospital were excluded.
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Affiliation(s)
- Glenn Larsson
- Department of Ambulance and Prehospital Care, Region Halland, Sweden; Department of Orthopaedics, Lund University, Sweden.
| | - Rn Ulf Strömberg
- Department of R&D, Region Halland, Sweden; Department of Cancer Epidemiology, Lund University, Sweden
| | - Cecilia Rogmark
- Department of Orthopaedics, Lund University, Sweden; Skane University Hospital, Malmö, Sweden
| | - Anna Nilsdotter
- Department of Orthopaedics, Lund University, Sweden; Department of R&D, Sahlgrenska University Hospital,Göteborg, Sweden
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Zozula A, Carpenter CR, Lipsey K, Stark S. Prehospital emergency services screening and referral to reduce falls in community-dwelling older adults: a systematic review. Emerg Med J 2016; 33:345-50. [DOI: 10.1136/emermed-2015-204815] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 11/29/2015] [Indexed: 11/04/2022]
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