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Enckell A, Laine MK, Roitto HM, Raina M, Kauppila T. Changes in location and number of nurse consultations as the supply of general practitioners decreases in primary health care: six-year register-based follow-up cohort study in the city of Vantaa, Finland. Scand J Prim Health Care 2024:1-7. [PMID: 38976004 DOI: 10.1080/02813432.2024.2375548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Accepted: 06/27/2024] [Indexed: 07/09/2024] Open
Abstract
OBJECTIVE To investigate whether the location and the number of nurse consultations have changed in response to the continuously decreasing number of GP consultations in the fourth-largest city in Finland. It has been suggested that nurse consultations are replacing GP consultations. DESIGN A retrospective register-based follow-up cohort study. SETTING Public primary health care in the City of Vantaa, Finland. SUBJECTS All documented face-to-face office-hour consultations with practical and registered nurses, and consultations with practical and registered nurse in the emergency department of Vantaa primary health care between 1 January 2009 and 31 December, 2014. MAIN OUTCOME MEASURES Change in the number of consultations with practical and registered nurses between 2009 and 2014 in primary health care both during office-hours and in the emergency department. RESULTS Over the follow-up period, the monthly median number of practical nurse consultations in the emergency department per 1000 inhabitants increased from 1.6 (interquartile range [IQR] 1.3-1.7) to 10.5 (10.3-12.2) (p < 0.001) and registered nurse consultations from a median of 3.6 (3.0-4.0) to 14.5 (13.0-16.6) (p < 0.001). However, there was no significant change in the median monthly number of office-hour consultations with practical or registered nurses. CONCLUSIONS It appears that in primary health care, medical consultations have shifted from GPs to nurses with lower education levels, and from care during office-hours to emergency care.
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Affiliation(s)
- Aina Enckell
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Western Uusimaa Wellbeing Services County, Finland
| | - Merja K Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Hanna-Maria Roitto
- Clinics of Internal Medicine and rehabilitation, Department of Geriatrics, University of Helsinki, and Helsinki University Hospital, Helsinki, Finland
- Population Health Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Marko Raina
- Wellbeing Services County of Vantaa and Kerava, Vantaa, Finland
- Apotti Ltd
| | - Timo Kauppila
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Yousefi Z, Feizollahzadeh H, Shahsavarinia K, Khodadadi E. The Impact of Team Triage Method on Emergency Department Performance Indexes: A quasi-interventional study. Int J Appl Basic Med Res 2023; 13:168-174. [PMID: 38023601 PMCID: PMC10666830 DOI: 10.4103/ijabmr.ijabmr_614_22] [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: 11/29/2022] [Revised: 04/15/2023] [Accepted: 08/31/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction One of the effective methods of patient triage in the emergency department (ED) is the use of team triage, including physicians and nurses. Considering that there is no conclusive evidence about the effectiveness of team triage, this study aimed to investigate the effect of the team triage method on ED performance indexes. Methods The present study is a quasi-interventional study in which 200 patients were referred to the ED in the hospitals of Tabriz in 2020. Participants were randomly assigned to two groups (team triage and conventional triage) and were evaluated. Data were collected by a three-part questionnaire including the participants' demographic characteristics, the five-level triage form, and Press-Ganey satisfaction questionnaire were used. Data were analyzed by SPSS.22 statistical software. Results The results showed that the mean score of waiting time for the first physician visit in team triage was statistically significantly lower than the conventional triage (P = 0.001). Furthermore, the mean score of waiting time for receiving the first treatment in team triage was statistically significantly lower than the conventional triage (P = 0.001). Finally, the mean score of patients' satisfaction in team and conventional triage was statistically significantly higher in team triage (P = 0.001). Conclusion The study findings revealed that the team triage method, in comparison to conventional triage, decrease the waiting time for receiving the first service and length of stay, but leads to more patient's satisfaction. Therefore, to improve the performance indicators of the ED, it is recommended that hospital managers use the team triage method.
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Affiliation(s)
- Zhila Yousefi
- Department of Medical Surgical Nursing, Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Feizollahzadeh
- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kavous Shahsavarinia
- Road Traffic Injury Research Center, Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Esmail Khodadadi
- Department of Education, Imam Reza Hospital, Social Security Organization, Urmia, Iran
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3
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Zalewska K, Zarzycka D. Best Educational Techniques in High-Fidelity Simulation According to Nursing Students-Adaptation and Validation of the Educational Practices Questionnaire (EPQ). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14688. [PMID: 36429406 PMCID: PMC9691004 DOI: 10.3390/ijerph192214688] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 11/05/2022] [Accepted: 11/07/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to evaluate the best educational techniques used during high-fidelity simulations in training nursing students and to introduce the Polish version of the Educational Practices Questionnaire (EPQ) scale after its cultural adaptation and determination of its psychometric properties. The research group was composed of 361 second- and third-year nursing students in the licentiate program. The Cronbach's alpha reliability coefficients for the adapted tool were 0.90 for the EPQ-PO (presence of educational techniques) subscale and 0.93 for the EPQ-IO subscale (importance of educational techniques). Additionally, the model fit rates in the CFA and EFA (as indicators of theoretical validity) proved to be high enough for the tool to be successfully used in scientific research. Preliminary results are also presented; the mean value of the response for the entire EPQ scale for both the PO and IO sections was M = 4.3, SD ± 0.90. The students in the study rated the opportunity for collaboration with other students and for working jointly on a given clinical situation very highly at M = 4.5, SD ± 0.70. The analysis of the scores of the individual scales and subscales of the EPQ showed statistically significant differences in results obtained for such variables as gender, place of residence, and year of studies.
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Affiliation(s)
| | - Danuta Zarzycka
- Department of Pediatric Nursing, Medical University of Lublin, 20-059 Lublin, Poland
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4
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Liedes-Kauppila M, Heikkinen AM, Rahkonen O, Lehto M, Mustonen K, Raina M, Kauppila T. Development of the use of primary health care emergency departments after interventions aimed at decreasing overcrowding: a longitudinal follow-up study. BMC Emerg Med 2022; 22:108. [PMID: 35701736 PMCID: PMC9195435 DOI: 10.1186/s12873-022-00667-9] [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: 10/01/2021] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
Background This study, conducted in a Finnish city, examined whether decreasing emergency department (ED) services in an overcrowded primary care ED and corresponding direction to office-hours primary care would modify service usage for specific gender, age or diagnosis groups. Methods This was an observational retrospective study carried out by gradually decreasing ED services in primary care. The interventions aimed at decreasing use of EDs were a) application of ABCDE-triage combined with public guidance on the proper use of EDs, b) closure of a minor supplementary ED, and finally, c) application of “reverse triage” with enhanced direction of the public to office-hours services and away from the remaining ED The annual number of visits to office-hours primary care GPs in different gender, age and diagnosis groups (International Classification of Diseases (ICD − 10) were recorded during a 13-year follow-up period. Results The total number of monthly visits to EDs decreased slowly over the whole study period. This decrease was similar in women and men. The decrease was stronger in the youngest age groups (0–19 years). GPs treated decreasing proportions of ICD-10 groups. Recorded infectious diseases (Groups A and J, and especially diagnoses related to infections of respiratory airways) tended to decrease. However, visits due to injuries and symptomatic diagnoses increased. Conclusion Decreasing services in a primary health care ED with the described interventions seemed to reduce the use of services by young people. The three interventions mentioned above had the effect of making the primary care ED under study appear to function more like a standard ED driven by specialized health care.
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Affiliation(s)
- Marja Liedes-Kauppila
- Department of Public Health, University of Helsinki, Finland, Biomedicum 2, Tukholmankatu 8 B, SF-00014 Helsingin yliopisto, Helsinki, Finland
| | - Anna M Heikkinen
- Department of Public Health, University of Helsinki, Finland, Biomedicum 2, Tukholmankatu 8 B, SF-00014 Helsingin yliopisto, Helsinki, Finland.,Department of Oral and Maxillofacial Diseases, Head and Neck Center, University of Helsinki, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Finland, Biomedicum 2, Tukholmankatu 8 B, SF-00014 Helsingin yliopisto, Helsinki, Finland
| | - Mika Lehto
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Vantaa Health Centre, Vantaa, Finland
| | - Katri Mustonen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | - Timo Kauppila
- Department of Public Health, University of Helsinki, Finland, Biomedicum 2, Tukholmankatu 8 B, SF-00014 Helsingin yliopisto, Helsinki, Finland.
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5
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Lehto M, Pitkälä K, Rahkonen O, Laine MK, Raina M, Kauppila T. The influence of electronic reminders on recording diagnoses in a primary health care emergency department: a register-based study in a Finnish town. Scand J Prim Health Care 2021; 39:113-122. [PMID: 33851565 PMCID: PMC8293956 DOI: 10.1080/02813432.2021.1910449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE This study examines whether implementation of electronic reminders is associated with a change in the amount and content of diagnostic data recorded in primary health care emergency departments (ED). DESIGN A register-based 12-year follow-up study with a before-and-after design. SETTING This study was performed in a primary health care ED in Finland. An electronic reminder was installed in the health record system to remind physicians to include the diagnosis code of the visit to the health record. SUBJECTS AND MAIN OUTCOME MEASURES The report generator of the electronic health record-system provided monthly figures for the number of different recorded diagnoses by using the International Classification of Diagnoses (ICD-10th edition) and the total number of ED physician visits, thus allowing the calculation of the recording rate of diagnoses on a monthly basis and the comparison of diagnoses before and after implementing electronic reminders. RESULTS The most commonly recorded diagnoses in the ED were acute upper respiratory infections of various and unspecified sites (5.8%), abdominal and pelvic pain (4.8%), suppurative and unspecified otitis media (4.5%) and dorsalgia (4.0%). The diagnosis recording rate in the ED doubled from 41.2 to 86.3% (p < 0.001) after the application of electronic reminders. The intervention especially enhanced the recording rate of symptomatic diagnoses (ICD-10 group-R) and alcohol abuse-related diagnoses (ICD-10 code F10). Mental and behavioural disorders (group F) and injuries (groups S-Y) were also better recorded after this intervention. CONCLUSION Electronic reminders may alter the documentation habits of physicians and recording of clinical data, such as diagnoses, in the EDs. This may be of use when planning resource managing in EDs and planning their actions.KEY POINTSElectronic reminders enhance recording of diagnoses in primary care but what happens in emergency departments (EDs) is not known.Electronic reminders enhance recording of diagnoses in primary care ED.Especially recording of symptomatic diagnoses and alcohol abuse-related diagnoses increased.
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Affiliation(s)
- Mika Lehto
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Vantaa Health Centre, City of Vantaa, Finland
| | - Kaisu Pitkälä
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Merja K. Laine
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Folkhälsan Research Centre, Helsinki, Finland
| | - Marko Raina
- Vantaa Health Centre, City of Vantaa, Finland
| | - Timo Kauppila
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Vantaa Health Centre, City of Vantaa, Finland
- CONTACT Timo Kauppila Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Biomedicum 2, Tukholmankatu 8 B FI-00014, Helsinki, Finland
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Lehto M, Mustonen K, Kantonen J, Raina M, Heikkinen AMK, Kauppila T. A Primary Care Emergency Service Reduction Did Not Increase Office-Hour Service Use: A Longitudinal Follow-up Study. J Prim Care Community Health 2020; 10:2150132719865151. [PMID: 31354021 PMCID: PMC6664635 DOI: 10.1177/2150132719865151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study, conducted in a Finnish city, examined whether decreasing emergency
department (ED) services in an overcrowded primary care ED and corresponding
direction to office-hour primary care would guide patients to office-hour visits
to general practitioners (GP). This was an observational retrospective study
based on a before-and-after design carried out by gradually decreasing ED
services in primary care. The interventions were (a)
application of ABCDE-triage combined with public guidance on the proper use of
EDs, (b) cessation of a minor supplementary ED, and finally
(c) application of “reverse triage” with enhanced direction
of the public to office-hour services from the remaining ED. The numbers of
visits to office-hour primary care GPs in a month were recorded before applying
the interventions fully (preintervention period) and in the postintervention
period. The putative effect of the interventions on the development rate of
mortality in different age groups was also studied as a measure of safety. The
total number of monthly visits to office-hour GPs decreased slowly over the
whole study period without difference in this rate between pre- and
postintervention periods. The numbers of office-hour GP visits per 1000
inhabitants decreased similarly. The rate of monthly visits to office-hour
GP/per GP did not change in the preintervention period but decreased in the
postintervention period. There was no increase in the mortality in any of the
studied age groups (0-19, 20-64, 65+ years) after application of the ED
interventions. There is no guarantee that decreasing activity in a primary care
ED and consecutive enhanced redirecting of patients to the office-hour primary
care systems would shift patients to office-hour GPs. On the other hand, this
decrease in the ED activity does not seem to increase mortality either.
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Affiliation(s)
| | - Katri Mustonen
- 2 Department of General Practice, University of Helsinki, Helsinki, Finland
| | | | | | | | - Timo Kauppila
- 1 City of Vantaa, Vantaa, Finland.,2 Department of General Practice, University of Helsinki, Helsinki, Finland.,3 University of Tampere, Tampere, Finland
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Berg H, Båtnes R, Steinsbekk A. Changes in performance during repeated in-situ simulations with different
cases. BMJ SIMULATION & TECHNOLOGY ENHANCED LEARNING 2020; 7:75-80. [PMID: 35520374 PMCID: PMC8769160 DOI: 10.1136/bmjstel-2019-000527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 05/05/2020] [Indexed: 11/06/2022]
Abstract
Introduction The aim was to describe changes in the performance of clinical actions, during repeated in-situ simulations with different cases, by teams of healthcare professionals with different experiences of the systematic clinical observation of deteriorating patients, after an introduction to the Airways, Breathing, Circulation, Disability,
Environment/Exposure (ABCDE) approach. Methods A descriptive observational study was conducted of repeated in-situ simulations using a patient simulator (SimMan 3G), carried out by teams in a public nursing home (NH, least experienced), an out-of-hours general practice (OOH-GP) service and a hospital emergency department (ED, most experienced). The cases had similar clinical presentations but different underlying diagnoses unknown to the teams. Four blinded clinical experts independently assessed the simulations on the basis of transcripts, providing comments, an overall score and scores for the clinical actions. Results The assessors commented on the overall lack of a systematic ABCDE approach in the NH and OOH-GP in all simulations, while the comments for the ED concerned the choice of treatment. Across the teams, the overall score was highest in the first simulation and second highest in the third simulation. The team in the NH received low overall scores for all simulations, but the last simulation received markedly better scores on the clinical actions. The teams in the OOH-GP and ED had no such clear pattern in the scores for clinical actions and thus no indications of improvement with repeated simulations. Conclusion The observation in this study was that the overall assessment by the blinded assessors showed no consistent improvement in clinical actions from repeated in-situ simulations, and the teams did not seem to adhere to the ABCDE approach throughout the simulations. This indicates that the teams were not able to apply their newly acquired experiences of using the ABCDE approach from one case to another, different case.
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Affiliation(s)
- Helen Berg
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ronald Båtnes
- Department of Health Sciences, Norwegian University of Science and Technology, Ålesund, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Opoku ST, Apenteng BA, Akowuah EA, Bhuyan S. Disparities in Emergency Department Wait Time Among Patients with Mental Health and Substance-Related Disorders. J Behav Health Serv Res 2019; 45:204-218. [PMID: 28815375 DOI: 10.1007/s11414-017-9565-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This study examined disparities in emergency department (ED) wait time for patients with mental health and substance-related disorders (PwMHSDs), using data from the 2009-2011 National Hospital Ambulatory Medical Care Survey (NHAMCS). Wait time was defined as the time between arrival at ED and being seen by an ED provider. Results from multivariable regression models show racial disparities, with non-Hispanic Black PwMHSDs experiencing longer ED wait time, compared to non-Hispanic White PwMHSDs. A temporal decline in ED wait time was also observed over the study period. The findings of this study have implications for informing the development of policies tailored at facilitating the delivery of equitable emergency care services to all PwMHSDs.
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Affiliation(s)
- Samuel T Opoku
- Department of Health Policy and Management Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA, 30460-8149, USA.
| | - Bettye A Apenteng
- Department of Health Policy and Management Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA, 30460-8149, USA
| | - Emmanuel A Akowuah
- Department of Health Policy and Management Jiann-Ping Hsu College of Public Health, Georgia Southern University, P.O. Box 8015, Statesboro, GA, 30460-8149, USA
| | - Soumitra Bhuyan
- Department of Health Systems Management and Policy, The University of Memphis, Memphis, TN, 38152, USA
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Mustonen K, Kantonen J, Kauppila T. The effect on the patient flow in local health care services after closing a suburban primary care emergency department: a controlled longitudinal follow-up study. Scand J Trauma Resusc Emerg Med 2017; 25:116. [PMID: 29183366 PMCID: PMC5706306 DOI: 10.1186/s13049-017-0460-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 11/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background It has not been studied what happens to patient flow to EDs and other parts of local health care system if distances to ED services are manipulated as a part of health policy in urban areas. Methods The present work was an observational and quasi-experimental study with a control and it was based on before-after comparisons. The impact of terminating a geographically distant suburban primary care ED on patient flow to doctors in local public primary care EDs, office-hour primary care, secondary care EDs and in private primary care was studied. The effect of this intervention was compared with a primary care system where no similar intervention was performed. The number of monthly visits to doctors in different departments of health care was scored as the main measure of the study in each department studied (e.g. in primary care EDs, secondary care ED, office-hour public primary care and private primary care). Monthly mortality rates were also recorded. Results Increasing the distance to ED services by terminating a peripheral ED did not cause an increase in the use of local office-hour services in those areas whose local ED was terminated, although use of ED services decreased by 25% in these areas (P < 0.001). The total use of primary care doctor services rather decreased - if anything - after this intervention while use of doctor services in secondary care ED remained unaffected. Doctor visits to the complementary private primary care increased but this was probably not associated with the intervention because a simultaneous increase in this parameter was observed in the control. There was no increased mortality in any age groups. Conclusion Manipulating distances to ED services can be used to direct patient flows to different parts of the health care system. The correlation between distance to ED and the tendency to use ED by inhabitants is negative. If secondary care ED was available there were no life-threatening side-effects at the level of general public health when a minor ED was closed in a primary care ED system.
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Affiliation(s)
- Katri Mustonen
- Department of Primary Health Care Laboratory Services, Helsinki University Central Hospital, Laboratory Services (HUSLAB), Topeliuksenkatu 32, 00029 HUS, Helsinki, Finland
| | - Jarmo Kantonen
- Primary Health Care, City of Vantaa, Peltolantie 2D, 01300, Vantaa, Finland
| | - Timo Kauppila
- Primary Health Care, City of Vantaa, Peltolantie 2D, 01300, Vantaa, Finland. .,Department of General Practice and Primary Health Care, Clinicum of Faculty of Medicine, University of Helsinki, (Tukholmankatu 8B), -00014, Helsinki, SF, Finland.
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10
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Kauppila T, Seppänen K, Mattila J, Kaartinen J. The effect on the patient flow in a local health care after implementing reverse triage in a primary care emergency department: a longitudinal follow-up study. Scand J Prim Health Care 2017; 35:214-220. [PMID: 28593802 PMCID: PMC5499323 DOI: 10.1080/02813432.2017.1333320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Reverse triage means that patients who are not considered to be in need of medical services are not placed on the doctor's list in an emergency department (ED) but are sent, after face-to-face evaluation by a triage nurse, to a more appropriate health care unit. It is not known how an abrupt application of such reverse triage in a combined primary care ED alters the demand for doctors' services in collaborative parts of the health care system. DESIGN An observational study. SETTING Register-based retrospective quasi-experimental longitudinal follow-up study based on a before-after setting in a Finnish city. SUBJECTS Patients who consulted different doctors in a local health care unit. MAIN OUTCOME MEASURES Numbers of monthly visits to different doctor groups in public and private primary care, and numbers of monthly referrals to secondary care ED from different sources of primary care were recorded before and after abrupt implementation of the reverse triage. RESULTS The beginning of reverse triage decreased the number of patient visits to a primary ED doctor without increasing mortality. Simultaneously, there was an increase in doctor visits in the adjacent secondary care ED and local private sector. The number of patients who came to secondary care ED without a referral or with a referral from the private sector increased. CONCLUSIONS The data suggested that the reverse triage causes redistribution of the use of doctors' services rather than a true decrease in the use of these services.
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Affiliation(s)
- Timo Kauppila
- Department of General Practice and Primary Health Care, Clinicum of Faculty of Medicine, Helsinki, Finland
- CONTACT Timo Kauppila , Department of General Practice and Primary Health Care, Clinicum of Faculty of Medicine, (Tukholmankatu 8B), Helsinki, SF-00014 University of Helsinki, Finland
| | - Katri Seppänen
- Department of Primary Health Care Laboratory Services, Helsinki University Central Hospital, Laboratory Services (HUSLAB), Helsinki, Finland
| | - Juho Mattila
- Department of Emergency Medicine, Helsinki University Hospital, Helsinki, Finland
| | - Johanna Kaartinen
- Department of Emergency Medicine, Helsinki University Hospital, Helsinki, Finland
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Oxelmark L, Nordahl Amorøe T, Carlzon L, Rystedt H. Students' understanding of teamwork and professional roles after interprofessional simulation-a qualitative analysis. Adv Simul (Lond) 2017; 2:8. [PMID: 29450009 PMCID: PMC5806292 DOI: 10.1186/s41077-017-0041-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/22/2017] [Indexed: 11/10/2022] Open
Abstract
Background This study explores how interprofessional simulation-based education (IPSE) can contribute to a change in students' understanding of teamwork and professional roles. A series of 1-day training sessions was arranged involving undergraduate nursing and medical students. Scenarios were designed for practicing teamwork principles and interprofessional communication skills by endorsing active participation by all team members. Methods Four focus groups occurred 2-4 weeks after the training. Thematic analysis of the transcribed focus groups was applied, guided by questions on what changes in students' understanding of teamwork and professional roles were identified and how such changes had been achieved. Results The first question, aiming to identify changes in students' understanding of teamwork, resulted in three categories: realizing and embracing teamwork fundamentals, reconsidering professional roles, and achieving increased confidence. The second question, regarding how participation in IPSE could support the transformation of students' understanding of teamwork and of professional roles, embraced another three categories: feeling confident in the learning environment, embodying experiences, and obtaining an outside perspective. Conclusions This study showed the potential of IPSE to transform students' understanding of others' professional roles and responsibilities. Students displayed extensive knowledge on fundamental teamwork principles and what these meant in the midst of participating in the scenarios. A critical prerequisite for the development of these new insights was to feel confident in the learning environment. The significance of how the environment was set up calls for further research on the design of IPSE in influencing role understanding and communicative skills in significant ways.
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Affiliation(s)
- Lena Oxelmark
- 1Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, PO Box 457, Gothenburg, SE 405 30 Sweden
| | - Torben Nordahl Amorøe
- 2Simulation Centre West, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Liisa Carlzon
- 2Simulation Centre West, Sahlgrenska University Hospital and University of Gothenburg, Gothenburg, Sweden
| | - Hans Rystedt
- 3Department of Education, Communication & Learning, University of Gothenburg, Gothenburg, Sweden
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