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Packendorff N, Magnusson C, Wibring K, Axelsson C, Hagiwara MA. Development of a trigger tool to identify harmful incidents, no harm incidents, and near misses in prehospital emergency care. Scand J Trauma Resusc Emerg Med 2024; 32:38. [PMID: 38685120 PMCID: PMC11059688 DOI: 10.1186/s13049-024-01209-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Emergency Medical Services (EMS) are a unique setting because care for the chief complaint is given across all ages in a complex and high-risk environment that may pose a threat to patient safety. Traditionally, a reporting system is commonly used to raise awareness of adverse events (AEs); however, it could fail to detect an AE. Several methods are needed to evaluate patient safety in EMS. In this light, this study was conducted to (1) develop a national ambulance trigger tool (ATT) with a guide containing descriptions of triggers, examples of use, and categorization of near misses (NMs), no harm incidents (NHIs), and harmful incidents (HIs) and (2) use the ATT on randomly selected ambulance records. METHODS The ambulance trigger tool was developed in a stepwise manner through (1) a literature review; (2) three sessions of structured group discussions with an expert panel having knowledge of emergency medical service, patient safety, and development of trigger tools; (3) a retrospective record review of 900 randomly selected journals with three review teams from different geographical locations; and (4) inter-rater reliability testing between reviewers. RESULTS From the literature review, 34 triggers were derived. After removing clinically irrelevant ones and combining others through three sessions of structured discussions, 19 remained. The most common triggers identified in the 900 randomly selected records were deviation from treatment guidelines (30.4%), the patient is non conveyed after EMS assessment (20.8%), and incomplete documentation (14.4%). The positive triggers were categorized as a near miss (40.9%), no harm (3.7%), and harmful incident (0.2%). Inter-rater reliability testing showed good agreement in both sessions. CONCLUSION This study shows that a trigger tool together with a retrospective record review can be used as a method to measure the frequency of harmful incidents, no harm incidents, and near misses in the EMS, thus complementing the traditional reporting system to realize increased patient safety.
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Affiliation(s)
- Niclas Packendorff
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Carl Magnusson
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristoffer Wibring
- Department of Ambulance and Prehospital Care, Region Halland, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christer Axelsson
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Larsson G, Eldh J, Hagman E, Andersson Hagiwara M. The non-conveyance of trauma patients in Swedish emergency medical services: a retrospective observational study of the trauma population not transported to an emergency department. BMC Emerg Med 2024; 24:34. [PMID: 38413853 PMCID: PMC10900607 DOI: 10.1186/s12873-024-00952-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/11/2024] [Indexed: 02/29/2024] Open
Abstract
INTRODUCTION Due to a systemic modification in Swedish emergency medical services (EMS) staffing in recent years, the nature of the Swedish EMS has changed. Transport to an emergency department (ED) is no longer the only option. Referrals and non-conveyance form a growing part of EMS assignments. Trauma is one of the most common causes of death and accounts for 17% of Swedish EMS assignments. The aim of this study was to describe the characteristics and clinical outcomes of non-conveyed trauma patients who were assessed, treated and triaged by the EMS to gain a better understanding of, and to optimise, transport and treatment decisions. METHODS The study had a descriptive, retrospective and epidemiologic design and was conducted by reviewing EMS and hospital records for 837 non-conveyed trauma patients in the southwest of Sweden in 2019. RESULTS Three in four non-conveyed trauma patients did not seek further medical care within 72 h following EMS assessment. The patients who were admitted to hospital later were often older, had suffered a fall and had a medical history. Half of all the incidents occurred in a domestic environment, and head trauma was the major complaint. Less than 1% of the studied patients died. CONCLUSION Most of the non-conveyed trauma patients did not seek further medical care after being discharged at the scene. Falling was the most common trauma event, and for the older population, this meant a higher risk of hospital admission. The reasons for falls should therefore be investigated thoroughly prior to non-conveyance decisions. Future studies should focus on the reasons for non-conveyance and measure the morbidity and invalidity outcomes rather than mortality.
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Affiliation(s)
- Glenn Larsson
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
- PICTA, Prehospital Innovation arena, Lindholmen Science Park, Gothenburg, Sweden
| | - Jana Eldh
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Elisabeth Hagman
- Faculty of Health and Society, Department of Care Science, Malmö University, SE-205 06, Malmö, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
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Wästerhed J, Ekenberg E, Hagiwara MA. Ambulance nurses' experiences as the sole caregiver with critical patients during long ambulance transports: an interview study. Scand J Trauma Resusc Emerg Med 2024; 32:6. [PMID: 38263118 PMCID: PMC10807097 DOI: 10.1186/s13049-024-01178-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Working in rural areas involves tackling long distances and occasional lack of supportive resources. Ambulance nurses are faced with the responsibility of making immediate autonomous decisions and providing extended care to critically ill patients during prolonged ambulance transport to reach emergency medical facilities. This study aims to expose the experiences of ambulance nurses acting as primary caregivers for critically ill patients during lengthy ambulance transfers in rural regions. METHOD Fifteen nurses employed in an ambulance service within sparsely populated rural areas were subjected to semi-structured interviews. The collected data underwent qualitative content analysis. RESULT The analysis resulted in one overarching theme with two categories. The theme is 'Safety in the Professional Role,' and the two categories are 'Working in sparsely populated areas presents challenges' and 'Rare events: when routine cannot be established.' The findings suggest that working as an ambulance nurse in a rural setting poses various challenges that can be highly stressful. Delivering care to critically ill patients during extended ambulance transports requires the knowledge, experience, and careful planning of the healthcare provider in charge. CONCLUSIONS The findings underscore the necessity for thorough planning and adaptable thinking when attending to critically ill patients during extended transport scenarios. The absence of supporting resources can render the task demanding. Nevertheless, participants reported an inherent tranquility that aids them in maintaining focus amid their responsibilities.
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Affiliation(s)
- Jenny Wästerhed
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare Boras, University of Borås, Borås, Sweden
| | - Erika Ekenberg
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare Boras, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare Boras, University of Borås, Borås, Sweden.
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Larsson G, Axelsson C, Hagiwara MA, Herlitz J, Klementsson H, Troëng T, Magnusson C. Epidemiology of patients assessed for trauma by Swedish ambulance services: a retrospective registry study. BMC Emerg Med 2024; 24:11. [PMID: 38191306 PMCID: PMC10775538 DOI: 10.1186/s12873-023-00924-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 12/26/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND There is a lack of knowledge regarding the epidemiology of severe trauma assessed by Swedish emergency medical services (EMS). AIM To investigate the prevalence of trauma in Sweden assessed by EMS from a national perspective and describe patient demography, aetiology, trauma type, prehospital triage and clinical outcomes. METHODS Data from two national quality registries, the Swedish Ambulance Registry and the Swedish Trauma Registry (SweTrau) were collected from January 1 to December 31, 2019. Inclusion criteria were an Emergency Symptoms and Signs code equivalent to trauma in the Swedish Ambulance Registry and criteria fulfilled for SweTrau inclusion. Exclusion criteria were patients < 18 years old, those not transported to a hospital and those without a personal identification number. RESULTS In total, 53,120 patients with trauma were included (14% of primary EMS missions involving a personal identification number). Of those, 2,278 (4.3%) patients (median age: 45 years; 32% women) were reported in SweTrau to have severe or potentially severe trauma (penetrating: 7%, blunt: 93%). In terms of including all causes of trauma, the code for 'trauma alert activation' was most frequent (55%). The most frequent injury mechanism was an injury caused by a car (34%). Most (89%) cases were assigned Priority 1 (life-threatening condition) at the dispatch centre. 62% were regarded as potentially life threatening upon EMS arrival, whereas 29% were assessed as non-life-threatening. Overall, 25% of the patients had new injury severity scores > 15. 12% required invasive treatment, 11% were discharged with severe disability and the 30-day mortality rate was 3.6%. CONCLUSION In this cross-sectional study, 14% of the primary EMS missions for one year were caused by trauma. However, only a small proportion of these cases are severe injuries, and the risk of severe disabilities and death appears to be limited. The most frequent aetiology of a severe trauma is injury caused by a car, and most severe traumas are blunt. Severe traumas are given the highest priority at the dispatch centre in the vast majority of cases, but nearly one-third of these cases are considered a low priority by the EMS nurse. The latter leaves room for improvement.
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Affiliation(s)
- Glenn Larsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden.
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
- PICTA, Prehospital Innovation Arena, Lindholmen Science Park, Gothenburg, Sweden.
| | - Christer Axelsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
| | - Johan Herlitz
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
| | | | | | - Carl Magnusson
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Herlitz J, Wireklint Sundström B, Andersson Hagiwara M, Lundgren P, Larsson G, Magnusson C, Wibring K, Axelsson C. [Documentation of prehospital emergency care]. Lakartidningen 2023; 120:23054. [PMID: 37860864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
The scientific documentation of prehospital emergency care in Sweden is slowly expanding. The first thesis on the value of a mobile coronary care unit was defended in 1982. Since then, at least 106 theses have been defended at 15 educational institutes in Sweden. The theses can be divided into nine different themes, of which acute disease and prognostic factors (n = 30) is the most common, followed in order of frequency by caring, assessment and decision (n = 18), patient and next of kin perspective (n = 14), trauma (n = 1 1), competence, learning, and education (n = 10), care needs, cooperation, and prioritization (n = 10), disaster (n = 7), workers' health and environment (n = 3), and ethics and values (n = 3). The University of Gothenburg had the highest number of theses defended (n = 28), followed by the Karolinska Institute (n = 24) and the University of Umeå (n = 10). The theses were written by 64 nurses, 36 physicians, two public health specialists, one physiotherapist, one priest, one social worker, and one statistician.
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Affiliation(s)
- Johan Herlitz
- leg läkare, senior professor, prehospital akutsjukvård, Prehospen, Högskolan i Borås
| | | | | | - Peter Lundgren
- leg läkare, med dr, kardiologkliniken, Sahlgrenska universitetssjukhuset; Prehospen, Högskolan i Borås
| | - Glenn Larsson
- leg sjuksköterska, med dr, Prehospen, Högskolan i Borås
| | - Carl Magnusson
- med dr, översjuksköterska, Ambulans och prehospital akutsjukvård, Sahlgrenska universitetssjukhuset, Göteborg
| | | | - Christer Axelsson
- leg sjuksköterska, professor i prehospital akutsjukvård, Prehospen, Högskolan i Borås
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Bakidou A, Caragounis EC, Andersson Hagiwara M, Jonsson A, Sjöqvist BA, Candefjord S. On Scene Injury Severity Prediction (OSISP) model for trauma developed using the Swedish Trauma Registry. BMC Med Inform Decis Mak 2023; 23:206. [PMID: 37814288 PMCID: PMC10561449 DOI: 10.1186/s12911-023-02290-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 09/04/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Providing optimal care for trauma, the leading cause of death for young adults, remains a challenge e.g., due to field triage limitations in assessing a patient's condition and deciding on transport destination. Data-driven On Scene Injury Severity Prediction (OSISP) models for motor vehicle crashes have shown potential for providing real-time decision support. The objective of this study is therefore to evaluate if an Artificial Intelligence (AI) based clinical decision support system can identify severely injured trauma patients in the prehospital setting. METHODS The Swedish Trauma Registry was used to train and validate five models - Logistic Regression, Random Forest, XGBoost, Support Vector Machine and Artificial Neural Network - in a stratified 10-fold cross validation setting and hold-out analysis. The models performed binary classification of the New Injury Severity Score and were evaluated using accuracy metrics, area under the receiver operating characteristic curve (AUC) and Precision-Recall curve (AUCPR), and under- and overtriage rates. RESULTS There were 75,602 registrations between 2013-2020 and 47,357 (62.6%) remained after eligibility criteria were applied. Models were based on 21 predictors, including injury location. From the clinical outcome, about 40% of patients were undertriaged and 46% were overtriaged. Models demonstrated potential for improved triaging and yielded AUC between 0.80-0.89 and AUCPR between 0.43-0.62. CONCLUSIONS AI based OSISP models have potential to provide support during assessment of injury severity. The findings may be used for developing tools to complement field triage protocols, with potential to improve prehospital trauma care and thereby reduce morbidity and mortality for a large patient population.
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Affiliation(s)
- Anna Bakidou
- Department of Electrical Engineering, Chalmers University of Technology, 412 96, Gothenburg, Sweden.
- Center for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.
| | - Eva-Corina Caragounis
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Per Dubbsgatan 15, 413 45, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- Center for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden
| | - Anders Jonsson
- Center for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden
| | - Bengt Arne Sjöqvist
- Department of Electrical Engineering, Chalmers University of Technology, 412 96, Gothenburg, Sweden
| | - Stefan Candefjord
- Department of Electrical Engineering, Chalmers University of Technology, 412 96, Gothenburg, Sweden
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Olander A, Andersson H, Sundler AJ, Hagiwara MA, Bremer A. The onset of sepsis as experienced by patients and family members: A qualitative interview study. J Clin Nurs 2023; 32:7402-7411. [PMID: 37277982 DOI: 10.1111/jocn.16785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 05/11/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
AIMS AND OBJECTIVES To explore the onset of sepsis based on patients' and family members' experiences. BACKGROUND Knowledge about the onset of sepsis is limited among patients and their families, which makes early recognition of sepsis difficult. Previous studies argue that their stories are important to recognising sepsis and reduced suffering and mortality. DESIGN A descriptive design with a qualitative approach was used. METHODS In total, 29 patients and family members participated in 24 interviews with open-ended questions, including five dyadic and 19 individual interviews. The interviews were conducted during 2021, and participants were recruited from a sepsis group on social media. A thematic analysis based on descriptive phenomenology was performed. The study followed the COREQ checklist. FINDINGS Two themes emerged from the experiences: (1) When health changes into something unknown, including the two subthemes; Bodily symptoms and signs being vague but still tangible and Feelings of uncertainty, and (2) Turning points when warnings signs are deemed as serious, including the two subthemes Passing borders when feeling out of control and Difficulties understanding the seriousness. CONCLUSIONS Patients' and family members' stories of the onset of sepsis indicate that symptoms and signs appeared insidiously and then noticeably worsen. The symptoms and signs seemed not be attributed to sepsis; instead, there was uncertainty about what the symptoms and signs meant. It was mainly family members who possibly understood the seriousness of the disease. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Patients' experiences of their symptoms and signs and family members' unique knowledge of the patient, indicate that healthcare professionals should listen and try to understand what the patient and family members are telling and take their concerns seriously. How the condition appears, and family members' concerns are important pieces of the assessment to recognise patients with sepsis. PATIENT OR PUBLIC CONTRIBUTION Patients and family members contributed to the data collected.
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Affiliation(s)
- Agnes Olander
- Centre for Prehospital Research, University of Borås, PreHospen, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Faculty of Health Science, Kristianstad University, Kristianstad, Sweden
| | - Henrik Andersson
- Centre for Prehospital Research, University of Borås, PreHospen, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Annelie J Sundler
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, University of Borås, PreHospen, Borås, Sweden
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Anders Bremer
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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Larsson G, Axelsson C, Hagiwara MA, Herlitz J, Magnusson C. Characteristics of a trauma population in an ambulance organisation in Sweden: results from an observational study. Scand J Trauma Resusc Emerg Med 2023; 31:33. [PMID: 37365663 DOI: 10.1186/s13049-023-01090-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Globally, injuries are a major health problem, and in Sweden, injuries are the second most common reason for ambulance dispatch. However, there is a knowledge gap regarding the epidemiology of injuries requiring assessment by emergency medical services (EMS) in Sweden. The aim of the present study was to describe the prehospital population with injuries that have been assessed and treated by EMS. METHODS A randomly selected retrospective sample was collected from 1 January through 31 December 2019 in a region in southwestern Sweden. Data were collected from ambulance and hospital medical records. RESULTS Among 153,724 primary assignments, 26,697 (17.4%) were caused by injuries. The study cohort consisted of 5,235 patients, of whom 50.5% were men, and the median age was 63 years. The most common cause of injury was low-energy fall (51.4%), and this was the cause in 77.8% of those aged > 63 years and in 26.7% of those aged ≤ 63 years. The injury mechanism was a motor vehicle in 8.0%, a motorcycle in 2.1% and a bicycle in 4.0%. The most common trauma location was the residential area (55.5% overall; 77.9% in the elderly and 34.0% in the younger group). In the prehospital setting, the most frequent clinical sign was a wound (33.2%), a closed fracture were seen in 18.9% and an open fracture in 1.0%. Pain was reported in 74.9% and 42.9% reported severe pain. Medication was given to 42.4% of patients before arrival in the hospital. The most frequent triage colour according to the RETTS was orange (46.7%), whereas only 4.4% were triaged red. Among all patients, 83.6% were transported to the hospital, and 27.8% received fracture treatment after hospital admission. The overall 30-day mortality rate was 3.4%. CONCLUSION Among EMS assignments in southwestern Sweden, 17% were caused by injury equally distributed between women and men. More than half of these cases were caused by low-energy falls, and the most common trauma location was a residential area. The majority of the victims had pain upon arrival of the EMS, and a large proportion appeared to have severe pain.
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Affiliation(s)
- Glenn Larsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden.
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Christer Axelsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
| | - Johan Herlitz
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Allegatan 1, 501 90, Borås, Sweden
| | - Carl Magnusson
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lee E, Sjöqvist BA, Hagiwara MA, Söderholm HM, Candefjord S. Development of Verified Innovation Process for Healthcare Solutions (VIPHS): A Stepwise Model for Digital Health. Stud Health Technol Inform 2023; 302:736-740. [PMID: 37203480 DOI: 10.3233/shti230250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Many digital health projects often stop in the pilot or test phase. Realisation of new digital health services is often challenging due to lack of guidelines for the step-by-step roll-out and implementation of the systems when changing work processes and procedures are needed. This study describes development of the Verified Innovation Process for Healthcare Solutions (VIPHS) - a stepwise model for digital health innovation and utilisation using service design principles. A multiple case study (two cases) involving participant observation, role play, and semi-structured interviews were conducted for the model development in prehospital settings. The model might be helpful to support realisation of innovative digital health projects in a holistic, disciplined, and strategic way.
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Affiliation(s)
- Eunji Lee
- Chalmers University of Technology, Gothenburg, Sweden
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Olander A, Magnusson C, Sundler AJ, Bremer A, Andersson H, Herlitz J, Axelsson C, Andersson Hagiwara M. Prediction of the Risk of Sepsis by Using Analysis of Plasma Glucose and Serum Lactate in Ambulance Services: A Prospective Study. Prehosp Disaster Med 2023; 38:160-167. [PMID: 36752111 DOI: 10.1017/s1049023x23000110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
INTRODUCTION The early recognition of patients with sepsis is difficult and the initial assessment outside of hospitals is challenging for ambulance clinicians (ACs). Indicators that ACs can use to recognize sepsis early are beneficial for patient outcomes. Research suggests that elevated point-of-care (POC) plasma glucose and serum lactate levels may help to predict sepsis in the ambulance service (AS) setting. STUDY OBJECTIVE The aim of this study was to test the hypothesis that the elevation of POC plasma glucose and serum lactate levels may help to predict Sepsis-3 in the AS. METHODS A prospective observational study was performed in the AS setting of Gothenburg in Sweden from the beginning of March 2018 through the end of September 2019. The criteria for sampling POC plasma glucose and serum lactate levels in the AS setting were high or intermediate risk according to the Rapid Emergency Triage and Treatment System (RETTS), as red, orange, yellow, and green if the respiratory rate was >22 breaths/minutes. Sepsis-3 were identified retrospectively. A primary and secondary analyses were carried out. The primary analysis included patients cared for in the AS and emergency department (ED) and were hospitalized. In the secondary analysis, patients who were only cared for in the AS and ED without being hospitalized were also included. To evaluate the predictive ability of these biomarkers, the area under the curve (AUC), sensitivity, specificity, and predictive values were used. RESULTS A total of 1,057 patients were included in the primary analysis and 1,841 patients were included in the secondary analysis. In total, 253 patients met the Sepsis-3 criteria (in both analyses). The AUC for POC plasma glucose and serum lactate levels showed low accuracy in predicting Sepsis-3 in both the primary and secondary analyses. Among all hospitalized patients, regardless of Sepsis-3, more than two-thirds had elevated plasma glucose and nearly one-half had elevated serum lactate when measured in the AS. CONCLUSIONS As individual biomarkers, an elevated POC plasma glucose and serum lactate were not associated with an increased likelihood of Sepsis-3 when measured in the AS in this study. However, the high rate of elevation of these biomarkers before arrival in hospital highlights that their role in clinical decision making at this early stage needs further evaluation, including other endpoints than Sepsis-3.
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Affiliation(s)
- Agnes Olander
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Carl Magnusson
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annelie J Sundler
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Anders Bremer
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
| | - Henrik Andersson
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
- Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
| | - Johan Herlitz
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Christer Axelsson
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Magnus Andersson Hagiwara
- University of Borås, PreHospen - Centre for Prehospital Research, Borås, Sweden
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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11
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Larsson G, Hansson P, Olsson E, Herlitz J, Hagiwara MA. Prehospital assessment of patients with abdominal pain triaged to self-care at home: an observation study. BMC Emerg Med 2022; 22:92. [PMID: 35659247 PMCID: PMC9164890 DOI: 10.1186/s12873-022-00649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients who call for emergency medical services (EMS) due to abdominal pain suffer from a broad spectrum of diseases, some of which are time sensitive. As a result of the introduction of the concept of 'optimal level of care', some patients with abdominal pain are triaged to other levels of care than in an emergency department (ED). We hypothesised that it could be challenging in a patient safety perspective. AIM This study aims to describe consecutive patients who call for EMS due to abdominal pain and are triaged to self-care by EMS clinicians. METHODS This was an observational study performed in an EMS organisation in Western Sweden during 2020. The triage tool Rapid Emergency Triage and Treatment System (RETTS), which included Emergency Signs and Symptom (ESS) codes, was used to find medical records where patients with abdominal pain have been triaged to self-care and 194 patients was included in the study. RESULTS Of total 48,311 ambulance missions, A total of 1747 patients were labelled with ESS code six (abdominal pain), including 223 (12.8%) who were given the code for self-care and 194 who were further assessed by the research group. Of these patients, 32 (16.3%) had a return visit within 96 hours due to the same symptoms and 11 (5.6%) were hospitalised. In six of these patients, the EMS triage was evaluated retrospectively and assessed as inappropriate. These patients had a final diagnosis of ruptured abdominal aneurysm (n = 1), acute appendicitis with peritonitis (n = 2) and acute pancreatitis (n = 3). All these patients required extensive evaluation and different treatments, including acute surgery, antibiotics and fluid therapy. CONCLUSION Amongst the 1747 patients assessed by EMS due to abdominal pain, 223 (12.8%) were triaged to self-care. Of the 194 patients who were further assessed, 16.3% required a return visit to the ED within 96 hours and 5.6% were hospitalised. Six patients had obvious time-sensitive conditions. Our study highlights the difficulties in the early assessment of abdominal pain and the requirement for an accurate decision support tool.
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Affiliation(s)
- Glenn Larsson
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.,Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Hansson
- NU Hospital Group (NU), Department of Ambulance Care, SE- 461 85, Trollhättan, Sweden
| | - Emelie Olsson
- NU Hospital Group (NU), Department of Ambulance Care, SE- 461 85, Trollhättan, Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
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12
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Magnusson C, Hagiwara MA, Norberg-Boysen G, Kauppi W, Herlitz J, Axelsson C, Packendorff N, Larsson G, Wibring K. Suboptimal prehospital decision- making for referral to alternative levels of care - frequency, measurement, acceptance rate and room for improvement. BMC Emerg Med 2022; 22:89. [PMID: 35606694 PMCID: PMC9125920 DOI: 10.1186/s12873-022-00643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/05/2022] [Indexed: 11/15/2022] Open
Abstract
Background The emergency medical services (EMS) have undergone dramatic changes during the past few decades. Increased utilisation, changes in care-seeking behaviour and competence among EMS clinicians have given rise to a shift in EMS strategies in many countries. From transport to the emergency department to at the scene deciding on the most appropriate level of care and mode of transport. Among the non-conveyed patients some may suffer from “time-sensitive conditions” delaying diagnosis and treatment. Thus, four questions arise:How often are time-sensitive cases referred to primary care or self-care advice? How can we measure and define the level of inappropriate clinical decision-making? What is acceptable? How to increase patient safety?
Main text To what extent time-sensitive cases are non-conveyed varies. About 5–25% of referred patients visit the emergency department within 72 hours, 5% are hospitalised, 1–3% are reported to have a time-sensitive condition and seven-day mortality rates range from 0.3 to 6%. The level of inappropriate clinical decision-making can be measured using surrogate measures such as emergency department attendances, hospitalisation and short-term mortality. These measures do not reveal time-sensitive conditions. Defining a scoring system may be one alternative, where misclassifications of time-sensitive cases are rated based on how severely they affected patient outcome. In terms of what is acceptable there is no general agreement. Although a zero-vision approach does not seem to be realistic unless under-triage is split into different levels of severity with zero-vision in the most severe categories. There are several ways to reduce the risk of misclassifications. Implementation of support systems for decision-making using machine learning to improve the initial assessment is one approach. Using a trigger tool to identify adverse events is another. Conclusion A substantial number of patients are non-conveyed, including a small portion with time-sensitive conditions. This poses a threat to patient safety. No general agreement on how to define and measure the extent of such EMS referrals and no agreement of what is acceptable exists, but we conclude an overall zero-vision is not realistic. Developing specific tools supporting decision making regarding EMS referral may be one way to reduce misclassification rates.
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Affiliation(s)
- Carl Magnusson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30, Gothenburg, Sweden. .,Department of Prehospital Emergency Care , Sahlgrenska University Hospital, SE-411 04, Gothenburg, Sweden.
| | - Magnus Andersson Hagiwara
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Gabriella Norberg-Boysen
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Wivica Kauppi
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Johan Herlitz
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Christer Axelsson
- Department of Prehospital Emergency Care , Sahlgrenska University Hospital, SE-411 04, Gothenburg, Sweden.,Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Niclas Packendorff
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Glenn Larsson
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Kristoffer Wibring
- Department of Ambulance and Prehospital Care, Region Halland, SE-302 49, Halmstad, Sweden
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13
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Johansson H, Lundgren K, Hagiwara MA. Reasons for bias in ambulance clinicians' assessments of non-conveyed patients: a mixed-methods study. BMC Emerg Med 2022; 22:79. [PMID: 35524195 PMCID: PMC9074185 DOI: 10.1186/s12873-022-00630-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background The number of ambulance assignments and the influx of patients to the emergency departments (EDs) in Sweden have increased in recent years. This is one reason the protocol for prehospital emergency care was developed around referring patients for non-conveyance, either through the see-and-convey elsewhere approach or through the see-and-treat approach. However, this protocol has led to challenges in patient assessments. This study aimed to investigate the underlying causes of patient harm among those referred for the see-and-treat approach by the emergency medical services. Methods This three-phase study involved a mixed-methods design. Cases of injuries, internal investigations and incident analyses of referrals for the see-and-treat approach in two regions in south eastern Sweden from 2015 to 2020 were examined using qualitative content analysis. This qualitative analysis was the basis for the quantitative analysis of the ambulance records. After the qualitative analysis was completed, a review protocol was developed; 34 variables were used to review 240 randomly selected ambulance records logged in 2020, wherein patients were referred for the see-and-treat approach. Finally, the review results were synthesised. Results The qualitative analysis revealed three common themes: ‘assessment of patients’, ‘guidelines’ and ‘environment and organisation’. These results were confirmed by a medical journal review. Shortcomings were found in the anamnesis and in the number of targeted examinations performed. The checklist for referring patients for the see-and-treat approach and the information sheet to be provided to the patients were not used. In 34% of the ambulance records examined, the EMS clinicians deviated from the current guidelines for a see-and-treat referral. Conclusions The results indicated that the low adherence to guidelines and the patient assessment deviating from the protocol put patients at risk of being harmed during a see-and-treat referral. Measures are needed to guarantee a safe assessment of an increasing number of patients who are referred for the see-and-treat approach, especially the multi-sick elderly patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12873-022-00630-8.
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Affiliation(s)
- Helena Johansson
- Falck Ambulans Östergötland, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Kristin Lundgren
- Ambulanssjukvården Region Jönköpings län, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
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14
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Holmgren C, Jussèn S, Hagiwara MA, Rådestad M. Charge nurses’ perceived experience in managing daily work and major incidents in emergency departments: A qualitative study. Australas Emerg Care 2022; 25:296-301. [DOI: 10.1016/j.auec.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/17/2022]
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15
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Herlitz J, Magnusson C, Andersson Hagiwara M, Lundgren P, Larsson G, Rawshani A, Axelsson C. [The role of prehospital emergency care in Sweden has changed - patient safety has become a key issue]. Lakartidningen 2021; 118:21119. [PMID: 34861043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Prehospital emergency care in Sweden has undergone dramatic changes in recent decades from the role of being a primary transport organization to a more differentiated approach to health care. The Swedish prehospital emergency nurse must therefore today make prehospital assessments to be able to decide whether patients should be transported to hospital with »fast-track« or sent to primary care or stay at home with advice on self-care. Therefore, »patient safety« has become a key issue and primary data indicate that there is a risk of a potential adverse event in approximately four percent of the primary assignments. Computer based decision support tools are under development and time-sensitive conditions need to be defined. We also need to further develop symptom-relieving therapy and the possibility of starting causal therapy already on the spot. Future perspectives include the use of biochemical markers as well as simple X-ray examinations to further improve pre-hospital assessment.
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Affiliation(s)
- Johan Herlitz
- leg läkare, senior professor, prehospital akutsjukvård, Prehospen, Högskolan i Borås
| | - Carl Magnusson
- leg sjuksköterska, med dr, ambulanssjukvården, Sahlgrenska universitetssjukhuset, Göteborg
| | | | - Peter Lundgren
- leg läkare, med dr, kardiologkliniken, Sahlgrenska universitetssjukhuset; Prehospen, Högskolan i Borås
| | - Glenn Larsson
- leg sjuksköterska, med dr, Prehospen, Högskolan i Borås
| | - Araz Rawshani
- leg läkare, med dr, kardiologkliniken, Sahlgrenska universitetssjukhuset, Göteborg
| | - Christer Axelsson
- leg sjuksköterska, professor i prehospital akutsjukvård, Prehospen, Högskolan i Borås
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16
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Olander A, Bremer A, Sundler AJ, Hagiwara MA, Andersson H. Assessment of patients with suspected sepsis in ambulance services: a qualitative interview study. BMC Emerg Med 2021; 21:45. [PMID: 33836665 PMCID: PMC8033740 DOI: 10.1186/s12873-021-00440-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/23/2021] [Indexed: 12/23/2022] Open
Abstract
Background The initial care of patients with sepsis is commonly performed by ambulance clinicians (ACs). Early identification, care and treatment are vital for patients with sepsis to avoid adverse outcomes. However, knowledge about how patients with sepsis are assessed in ambulance services (AS) by AC is limited. Therefore, the aim of this study was to explore the meaning of ACs’ lived experiences in assessing patients suspected of having sepsis. Methods A descriptive design with a qualitative approach was used. Fourteen ACs from three Swedish ambulance organizations participated in dyadic and individual semistructured interviews. A thematic analysis based on descriptive phenomenology was performed. Results AC experiences were grouped into four themes: (1) being influenced by previous experience; (2) searching for clues to the severity of the patient’s condition; (3) feeling confident when signs and symptoms were obvious; and (4) needing health-care professionals for support and consultation. Conclusions This study indicates that several factors are important to assessments. ACs needed to engage in an ongoing search for information, discuss the cases with colleagues and reconsider the assessment throughout the entire ambulance mission. A reflective and open stance based on professional knowledge could contribute to recognizing patients with sepsis.
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Affiliation(s)
- Agnes Olander
- University of Borås, PreHospen, Centre for Prehospital Research, SE- 405 30, Borås, Sweden. .,University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.
| | - Anders Bremer
- University of Borås, PreHospen, Centre for Prehospital Research, SE- 405 30, Borås, Sweden.,University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden.,Linnaeus University, Faculty of Health and Life Sciences, Växjö, Sweden
| | - Annelie J Sundler
- University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Magnus Andersson Hagiwara
- University of Borås, PreHospen, Centre for Prehospital Research, SE- 405 30, Borås, Sweden.,University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
| | - Henrik Andersson
- University of Borås, PreHospen, Centre for Prehospital Research, SE- 405 30, Borås, Sweden.,University of Borås, Faculty of Caring Science, Work Life and Social Welfare, Borås, Sweden
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17
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Sterner A, Ramstrand N, Palmér L, Hagiwara MA. A study of factors that predict novice nurses' perceived ability to provide care in acute situations. Nurs Open 2021; 8:1958-1969. [PMID: 33798279 PMCID: PMC8186698 DOI: 10.1002/nop2.871] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 02/17/2021] [Accepted: 03/15/2021] [Indexed: 01/10/2023] Open
Abstract
AIMS To explore factors that predict novice nurses' trust in their ability to provide care in acute situations and identify factors that are related to their perceived ability to make clinical judgements in acute situations. DESIGN Exploratory cross-sectional study. METHODS Novice nurses employed within somatic care in Swedish hospitals completed an online survey. Univariate analysis facilitated exploration of the data and identification of predictor variables with the greatest association with: (1) trust in their own ability (one item) and (2) ability to make clinical judgements (four items). Multivariate binary logistic regression modelling was used to model the likelihood of outcomes based on each predictor variable. RESULTS The two most important predictors related to trust in ability to provide care were duration of work experience and participation in acute situations during nursing education. For clinical judgement, duration of work experience was significant in all four models and experience of acute situations post-graduation was significant in two models.
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Affiliation(s)
- Anders Sterner
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Nerrolyn Ramstrand
- Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Lina Palmér
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Faculty of Caring Science, Work Life and Social Welfare, Centre for Prehospital Research, University of Borås, Borås, Sweden
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18
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Magnusson C, Lövgren E, Alfredsson J, Axelsson C, Andersson Hagiwara M, Rosengren L, Herlitz J, Jood K. Difficulties in the prehospital assessment of patients with TIA/stroke. Acta Neurol Scand 2021; 143:318-325. [PMID: 33141437 DOI: 10.1111/ane.13369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/12/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND In patients with TIA/stroke, early assessment is critical. AIM To describe patients who were not directly transported to hospital by ambulance after prehospital assessment. METHODS Patients hospitalized with TIA/stroke in Gothenburg, Data were obtained from the EMS and hospital case record system. RESULTS There were 7,812 patients with TIA/stroke, of which 4,853 (62%) were candidates for EMS transport. Among them, 176 (3.6%) were not directly transported to hospital by ambulance. In 45% of them, delay from symptom onset to calling for EMS was ≤24 hours. On EMS arrival, common symptom was dizziness (28%), followed by weakness in arm or leg (21%), loss of sensibility (13%), speech disturbances (7%), and facial numbness (4%). The modified National Institute of Health Stroke Score (mNIHSS) was 0 in 80% and >1 in two per cent. The NIHSS at the emergency department was 1-4 in 39% and 5-15 in six per cent. The EMS clinician made the decision not to transport the patient to hospital by the EMS in 84%, the dispatcher in 12% and the patient or relatives in four per cent. Patients were involved in the decision in 51%. Final diagnosis was stroke in 74% and the proportion who were independent in normal daily activities at hospital discharge decreased by 15% compared with before event. CONCLUSION About 3%-4% of patients with TIA/stroke were not directly transported to hospital by EMS after prehospital assessment. The most common symptom was dizziness. Decision-support tools for EMS to identify time-sensitive conditions are required.
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Affiliation(s)
- Carl Magnusson
- Department of Molecular and Clinical Medicine Institute of Medicine The Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Erik Lövgren
- The Department of Emergency Care in South Älvsborg Borås Sweden
| | | | - Christer Axelsson
- Centre for Prehospital Research – Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research – Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Lars Rosengren
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
| | - Johan Herlitz
- Centre for Prehospital Research – Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience Institute of Neuroscience and Physiology The Sahlgrenska Academy at the University of Gothenburg Gothenburg Sweden
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19
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Bremer A, Andersson Hagiwara M, Tavares W, Paakkonen H, Nyström P, Andersson H. Translation and further validation of a global rating scale for the assessment of clinical competence in prehospital emergency care. Nurse Educ Pract 2020; 47:102841. [PMID: 32768897 DOI: 10.1016/j.nepr.2020.102841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 05/30/2020] [Accepted: 07/13/2020] [Indexed: 10/23/2022]
Abstract
Global rating scales are useful to assess clinical competence at a general level based on specific word dimensions. The aim of this study was to translate and culturally adapt the Paramedic Global Rating Scale, and to contribute validity evidence and instrument usefulness in training results and clinical competence assessments of students undergoing training to become ambulance nurses and paramedics at Swedish and Finnish universities. The study included translation, expert review and inter-rater reliability (IRR) tests. The scale was translated and culturally adapted to clinical and educational settings in both countries. A content validity index (CVI) was calculated using eight experts. IRR tests were performed with five registered nurses working as university lecturers, and with six clinicians working as ambulance nurses. They individually rated the same simulated ambulance assignment. Based on the ratings IRR was calculated with intra-class correlation (ICC). The scale showed excellent CVI for items and scale. The ICC indicated substantial agreement in the group of lecturers and a high degree of agreement in the group of clinicians. This study provides validity evidence for a Swedish version of the scale, supporting its use in measuring clinical competence among students undergoing training to become ambulance nurses and paramedics.
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Affiliation(s)
- Anders Bremer
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden; Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
| | - Magnus Andersson Hagiwara
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Walter Tavares
- The Wilson Centre, Department of Medicine, University of Toronto/University Health Network, Toronto, Canada; Post-MD Education (Post-Graduate Medical Education/Continued Professional Development), University of Toronto, Toronto, Canada; Paramedic and Senior Services, Community and Health Services Department, Regional Municipality of York, Newmarket, ON, Canada.
| | - Heikki Paakkonen
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland.
| | - Patrik Nyström
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland.
| | - Henrik Andersson
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
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20
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Packendorff N, Gustavsson V, Magnusson C, Andersson Hagiwara M, Jood K, Herlitz J, Axelsson C. Outcome among patients who call the emergency medical service (EMS) due to dizziness. Australas Emerg Care 2020; 24:61-66. [PMID: 32682695 DOI: 10.1016/j.auec.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/05/2020] [Accepted: 07/03/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patient with dizziness are challenging in prehospital care. The aim was to describe final diagnosis among patients assessed by EMS as suffering from dizziness with focus on time-critical conditions. METHODS Consecutive patients assessed by an EMS clinician during 12 months in a single large EMS system in Gothenburg, Sweden (660,000 inhabitants), were assessed. The study comprised patients given ESS code 11 dizziness. The main end-point was the final diagnosis (ICD code). RESULTS There were 58,575 primary missions, of which 2,048 (3.5%) were assessed as ESS code 11 (dizziness). Of these, 161 (8%) were excluded. Among the remaining 1887 cases, there were 230 different ICD codes and 96 (5%) had a time-critical condition. The majority (88%) had a cerebrovascular disease. The most typical symptoms among time-critical conditions were an acute onset (63%) and nausea, vomiting (61%). When compared with non-time-critical conditions, those with time-critical conditions were older and had a higher median systolic blood pressure at EMS arrival. CONCLUSION Among primary missions by the EMS, 3.5% had dizziness. Of these, 5% had a time-critical condition and the majority had a cerebrovascular disease. Instruments to identify time-critical conditions among patients seen by EMS due to dizziness are required.
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Affiliation(s)
| | | | - Carl Magnusson
- Institute of Medicine, Department of Molecular and Clinical Medicine, The Sahlgrenska Academy, Gothenburg University, SE-405 30 Gothenburg, Sweden.
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden.
| | - Katarina Jood
- Department of Clinical Neuroscience and Physiology, The Sahlgrenska Academy University of Gothenburg, SE-405 30 Gothenburg, Sweden.
| | - Johan Herlitz
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden.
| | - Christer Axelsson
- Centre for Prehospital Research Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden.
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21
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Sterner A, Säfström E, Palmér L, Ramstrand N, Hagiwara MA. Development and initial validation of an instrument to measure novice nurses' perceived ability to provide care in acute situations - PCAS. BMC Nurs 2020; 19:13. [PMID: 32095115 PMCID: PMC7027289 DOI: 10.1186/s12912-020-0406-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/11/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Novice nurses need to be better prepared to provide care in acute situations. There is currently no validated scale specifically measuring nurses' perception of their ability to provide care in acute situations. The aim of this study was to develop and examine the psychometric properties of a scale that measures novice nurses self-reported perception of ability to provide care in acute situations. METHOD Development and test of the psychometric properties of the Perception to Care in Acute Situations (PCAS) scale. Items were generated from interviews with novice nurses (n = 17) and validated using opinions of an expert panel and cognitive interviews with the target group.Two hundred nine novice nurses tested the final scale. Exploratory factor analysis (EFA) was used to test construct validity, item reduction and underlying dimensions between the measured variables and the latent construct. RESULT The PCAS scale contains 17 items grouped into three factors. EFA demonstrated a clean three factor logic construct solution with no cross-loadings, high correlation for the total scale in both Cronbach's alfa 0.90 and ordinal alpha 0.92. CONCLUSIONS The PCAS scale has proven to have acceptable validity. The factors," confidence in provision of care", "communication" and "patient perspective" are likely to be important aspects of providing care in acute situations. Additional testing of the PCAS is needed to conclude if it is sensitive enough to evaluate interventions aimed at improving novice nurses competence and suitable as a guide for reflection for novice nurses.
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Affiliation(s)
- Anders Sterner
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Emma Säfström
- Department of Medical and Health Sciences, Linköping University, 581 83 Linköping, Sweden
| | - Lina Palmér
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Nerrolyn Ramstrand
- CHILD research group, Department of Rehabilitation, School of Health Sciences, Jönköping University, 551 11 Jönköping, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90 Borås, Sweden
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22
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Andersson U, Maurin Söderholm H, Wireklint Sundström B, Andersson Hagiwara M, Andersson H. Clinical reasoning in the emergency medical services: an integrative review. Scand J Trauma Resusc Emerg Med 2019; 27:76. [PMID: 31426839 PMCID: PMC6700770 DOI: 10.1186/s13049-019-0646-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Accepted: 07/15/2019] [Indexed: 11/25/2022] Open
Abstract
Abstract Clinical reasoning is the process of gathering and understanding information conducted by clinicians in the emergency medical services (EMS) so as to make informed decisions. Research on clinical reasoning spans several disciplines, but a comprehensive view of the process is lacking. To our knowledge, no review of clinical reasoning in the EMS has been conducted. Aim The aim was to investigate the nature, deployment, and factors influencing EMS clinicians’ clinical reasoning by means of a review. Method Data was collected through searches in electronic databases, networking among research teams, colleagues and friends, “grey literature,” and through ancestry searches. A total of 38 articles were deemed eligible for inclusion and were analyzed using descriptive thematic analysis. The analysis resulted in an overarching finding - namely, the importance for EMS clinicians to adjust for perceived control in unpredictable situations. Within this finding, 3 themes emerged in terms of EMS clinicians’ clinical reasoning: (1) maintaining a holistic view of the patient; (2) keeping an open mind; and (3) improving through criticism. Seven subthemes subsequently emerged from these three themes. Results This review showed that EMS clinicians’ clinical reasoning begins with the information that they are given about a patient. Based on this information, clinicians calculate the best route to the patient and which equipment to use, and they also assess potential risks. They need to be constantly aware of what is happening on the scene and with the patient and strive to control the situation. This striving also enables EMS clinicians to work safely and effectively in relation to the patient, their relatives, other clinicians, associated organizations, and the wider community. A lack of contextually appropriate guidelines results in the need for creativity and forces EMS clinicians to use “workarounds” to solve issues beyond the scope of the guidelines available. In addition, they often lack organizational support and fear repercussions such as litigation, unemployment, or blame by their EMS or healthcare organization or by patients and relatives. Conclusion Clinical reasoning is influenced by several factors. Further research is needed to determine which influencing factors can be addressed through interventions to minimize their impact on patient outcomes. Electronic supplementary material The online version of this article (10.1186/s13049-019-0646-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ulf Andersson
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden. .,PreHospen-Centre for Prehospital Research, University of Borås, Borås, Sweden.
| | - Hanna Maurin Söderholm
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden.,PreHospen-Centre for Prehospital Research, University of Borås, Borås, Sweden.,Swedish School of Library and Information Science, University of Borås, Borås, Sweden
| | - Birgitta Wireklint Sundström
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden.,PreHospen-Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden.,PreHospen-Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Henrik Andersson
- Faculty of Caring Science, Work Life, and Social Welfare, University of Borås, Borås, Sweden.,PreHospen-Centre for Prehospital Research, University of Borås, Borås, Sweden
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23
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Olander A, Andersson H, Sundler AJ, Bremer A, Ljungström L, Andersson Hagiwara M. Prehospital characteristics among patients with sepsis: a comparison between patients with or without adverse outcome. BMC Emerg Med 2019; 19:43. [PMID: 31387528 PMCID: PMC6685242 DOI: 10.1186/s12873-019-0255-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/19/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND The prehospital care of patients with sepsis are commonly performed by the emergency medical services. These patients may be critically ill and have high in-hospital mortality rates. Unfortunately, few patients with sepsis are identified by the emergency medical services, which can lead to delayed treatment and a worse prognosis. Therefore, early identification of patients with sepsis is important, and more information about the prehospital characteristics that can be used to identify these patients is needed. Based on this lack of information, the objectives of this study were to investigate the prehospital characteristics that are identified while patients with sepsis are being transported to the hospital by the emergency medical services, and to compare these values to those of the patients with and without adverse outcomes during their hospital stays. METHODS This was a retrospective observational study. The patients' electronic health records were reviewed and selected consecutively based on the following: retrospectively diagnosed with sepsis and transported to an emergency department by the emergency medical services. Data were collected on demographics, prehospital characteristics and adverse outcomes, defined as the in-hospital mortality or treatment in the intensive care unit, and analysed by independent sample t-test and chi-square. Sensitivity, specificity and likelihood ratio, of prehospital characteristics for predicting or development of adverse outcome were analysed. RESULTS In total, 327 patients were included. Of these, 50 patients had adverse outcomes. When comparing patients with or without an adverse outcome, decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care were found to be associated with an adverse outcome. CONCLUSIONS The findings suggests that patients having a decreased oxygen saturation and body temperature, increased serum glucose level and altered mental status during prehospital care are at risk of a poorer patient prognosis and adverse outcome. Recognizing these prehospital characteristics may help to identify patients with sepsis early and improve their long-term outcomes. However further research is required to predict limit values of saturation and serum glucose and to validate the use of prehospital characteristics for adverse outcome in patients with sepsis.
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Affiliation(s)
- Agnes Olander
- PreHospen - Centre for Prehospital Research, University of Borås, Allégatan 1, SE- 405 30, Borås, Sweden. .,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
| | - Henrik Andersson
- PreHospen - Centre for Prehospital Research, University of Borås, Allégatan 1, SE- 405 30, Borås, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Annelie J Sundler
- PreHospen - Centre for Prehospital Research, University of Borås, Allégatan 1, SE- 405 30, Borås, Sweden
| | - Anders Bremer
- PreHospen - Centre for Prehospital Research, University of Borås, Allégatan 1, SE- 405 30, Borås, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Lars Ljungström
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Infectious Diseases, Skaraborg Hospital, RegionVästra Götaland, Skövde, Sweden
| | - Magnus Andersson Hagiwara
- PreHospen - Centre for Prehospital Research, University of Borås, Allégatan 1, SE- 405 30, Borås, Sweden.,Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
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24
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Hansson P, Andersson Hagiwara M, Herlitz J, Brink P, Wireklint Sundström B. Prehospital assessment of suspected stroke and TIA: An observational study. Acta Neurol Scand 2019; 140:93-99. [PMID: 31009075 DOI: 10.1111/ane.13107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/06/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Symptoms related to stroke diverge and may mimic many other conditions. AIMS To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA). METHODS An observational multicenter study includes nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the emergency medical service clinician before hospital admission during a four-month period were included. RESULTS Of 1081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, P = 0.007, a history of myocardial infarction (OR: 1.77, P = 0.01), facial droop (OR: 2.81, P < 0.0001), arm weakness (OR: 2.61, P < 0.0001), speech disturbance (OR: 1.92, P < 0.0001), and high systolic blood pressure (OR: 1.50, P = 0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, P = 0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up. CONCLUSIONS Seven factors including the three symptoms included in the Face Arm Speech Test were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke.
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Affiliation(s)
- Per‐Olof Hansson
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Peter Brink
- Intensive Care Unit NU‐Hospital Trollhättan Sweden
| | - Birgitta Wireklint Sundström
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
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25
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Andersson Hagiwara M, Lundberg L, Sjöqvist BA, Maurin Söderholm H. The Effects of Integrated IT Support on the Prehospital Stroke Process: Results from a Realistic Experiment. J Healthc Inform Res 2019; 3:300-328. [PMID: 35415430 PMCID: PMC8982745 DOI: 10.1007/s41666-019-00053-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 04/24/2019] [Accepted: 04/25/2019] [Indexed: 12/03/2022]
Abstract
Stroke is a serious condition and the stroke chain of care is a complex. The present study aims to explore the impact of a computerised decision support system (CDSS) for the prehospital stroke process, with focus on work processes and performance. The study used an exploratory approach with a randomised controlled crossover design in a realistic contextualised simulation experiment. The study compared clinical performance among 11 emergency medical services (EMS) teams of 22 EMS clinicians using (1) a computerised decision support system (CDSS) and (2) their usual paper-based process support. Data collection consisted of video recordings, postquestionnaires and post-interviews, and data were analysed using a combination of qualitative and quantitative approaches. In this experiment, using a CDSS improved patient assessment, decision making and compliance to process recommendations. Minimal impact of the CDSS was found on EMS clinicians’ self-efficacy, suggesting that even though the system was found to be cumbersome to use it did not have any negative effects on self-efficacy. Negative effects of the CDSS include increased on-scene time and a cognitive burden of using the system, affecting patient interaction and collaboration with team members. The CDSS’s overall process advantage to the prehospital stroke process is assumed to lead to a prehospital care that is both safer and of higher quality. The key to user acceptance of a system such as this CDSS is the relative advantages of improved documentation process and the resulting patient journal. This could improve the overall prehospital stroke process.
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Affiliation(s)
- Magnus Andersson Hagiwara
- PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Lars Lundberg
- PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Bengt Arne Sjöqvist
- Department of Electrical Engineering, Biomedical Signals and Systems, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
| | - Hanna Maurin Söderholm
- PreHospen-Centre for Prehospital Research, Faculty of Librarianship, Information, Education and IT, University of Borås, SE-501 90 Borås, Sweden
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26
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Alsholm L, Axelsson C, Andersson Hagiwara M, Niva M, Claesson L, Herlitz J, Magnusson C, Rosengren L, Jood K. Interrupted transport by the emergency medical service in stroke/transitory ischemic attack: A consequence of changed treatment routines in prehospital emergency care. Brain Behav 2019; 9:e01266. [PMID: 30980519 PMCID: PMC6520471 DOI: 10.1002/brb3.1266] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 02/26/2019] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The discovery that not all patients who call for the emergency medical service (EMS) require transport to hospital has changed the structure of prehospital emergency care. Today, the EMS clinician at the scene already distinguishes patients with a time-critical condition such as stroke/transitory ischemic attack (TIA) from patients without. This highlights the importance of the early identification of stroke/TIA. AIM To describe patients with a final diagnosis of stroke/TIA whose transport to hospital was interrupted either due to a lack of suspicion of the disease by the EMS crew or due to refusal by the patient or a relative/friend. METHODS Data were obtained from a register in Gothenburg, covering patients hospitalised due to a final diagnosis of stroke/TIA. The inclusion criterion was that patients were assessed by the EMS but were not directly transported to hospital by the EMS. RESULTS Among all the patients who were assessed by the EMS nurse and subsequently diagnosed with stroke or TIA in 2015, the transport of 34 of 1,310 patients (2.6%) was interrupted. Twenty-five of these patients, of whom 20 had a stroke and five had a TIA, are described in terms of initial symptoms and outcome. The majority had residual symptoms at discharge from hospital. Initial symptoms were vertigo/disturbed balance in 11 of 25 cases. Another three had symptoms perceived as a change in personality and three had a headache. CONCLUSION From this pilot study, we hypothesise that a fraction of patients with stroke/TIA who call for the EMS have their direct transport to hospital interrupted due to a lack of suspicion of the disease by the EMS nurse at the scene. These patients appear to have more vague symptoms including vertigo and disturbed balance. Instruments to identify these patients at the scene are warranted.
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Affiliation(s)
- Linda Alsholm
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Christer Axelsson
- Prehospen-Centre of Prehosp Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Prehospen-Centre of Prehosp Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - My Niva
- Department of Ambulance Care, Jönköping County Hospital, Jönköping, Sweden
| | - Lisa Claesson
- Department of Ambulance Care, Halland County Hospital, Varberg, Sweden
| | - Johan Herlitz
- Prehospen-Centre of Prehosp Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Carl Magnusson
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Rosengren
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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27
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Sterner A, Hagiwara MA, Ramstrand N, Palmér L. Factors developing nursing students and novice nurses' ability to provide care in acute situations. Nurse Educ Pract 2019; 35:135-140. [PMID: 30818117 DOI: 10.1016/j.nepr.2019.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 11/23/2018] [Accepted: 02/13/2019] [Indexed: 01/22/2023]
Abstract
Nurses play an important role in detecting, interpreting and deciding appropriate actions to take in order to care for patients in acute situations. Nevertheless, novice nurses are reported as feeling unprepared to provide appropriate care in acute situations. In order to address this issue, it is important to describe factors in nursing education and first year of practice that enable nurses to provide appropriate care in acute situations. 17 novice nurses were interviewed in this qualitative study. A phenomenographic analysis was applied and four categories were discovered: Integrating theory into practice, access to adequate support, experience-based knowledge and personality traits. Results suggest that a variety of factors contribute to novice nurses' ability to provide appropriate care in acute situations. Experience of acute situations and the integration of theory and practice are pivotal in acquiring skills to provide appropriate care. To accomplish this, reflection, practice and/or applied training with a patient perspective is recommended.
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Affiliation(s)
- Anders Sterner
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden.
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden
| | - Nerrolyn Ramstrand
- CHILD Research Group, Department of Rehabilitation, School of Health Sciences, Jönköping University, 551 11, Jönköping, Sweden
| | - Lina Palmér
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, 501 90, Borås, Sweden
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28
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Maurin Söderholm H, Andersson H, Andersson Hagiwara M, Backlund P, Bergman J, Lundberg L, Sjöqvist BA. Research challenges in prehospital care: the need for a simulation-based prehospital research laboratory. Adv Simul (Lond) 2019; 4:3. [PMID: 30783539 PMCID: PMC6375122 DOI: 10.1186/s41077-019-0090-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 02/05/2019] [Indexed: 11/20/2022] Open
Abstract
There is a need for improved research in the field of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. The present paper argues for the potential of simulation for prehospital research, e.g., through the development of an advanced simulation-based prehospital research laboratory. However, the prehospital context is different from other healthcare areas, which implies special requirements for the design of this type of laboratory, in terms of simulation width (including the entire prehospital work process) and depth (level of scenario detail). A set of features pertaining to simulation width, scenario depth, equipment, and personnel and competence are proposed. Close tailoring between these features and the prehospital research problems and context presents great potential to improve and further prehospital research.
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Affiliation(s)
- Hanna Maurin Söderholm
- 1PreHospen - Centre for Prehospital Research, Faculty of Librarianship, Information, Education and IT, University of Borås, SE-501 90 Borås, Sweden
| | - Henrik Andersson
- 2PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Magnus Andersson Hagiwara
- 2PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Per Backlund
- 3School of Informatics, University of Skövde, Box 408, SE-541 28 Skövde, Sweden
| | - Johanna Bergman
- PICTA - Prehospital ICT Arena, Lindholmen Science Park AB, SE-402 78 Göteborg, Sweden
| | - Lars Lundberg
- 2PreHospen - Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90 Borås, Sweden
| | - Bengt Arne Sjöqvist
- 5Biomedical Signals and Systems, Department of Electrical Engineering, Chalmers University of Technology, SE-412 96 Gothenburg, Sweden
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29
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Hagiwara MA, Magnusson C, Herlitz J, Seffel E, Axelsson C, Munters M, Strömsöe A, Nilsson L. Adverse events in prehospital emergency care: a trigger tool study. BMC Emerg Med 2019; 19:14. [PMID: 30678636 PMCID: PMC6345067 DOI: 10.1186/s12873-019-0228-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/15/2019] [Indexed: 11/30/2022] Open
Abstract
Background Prehospital emergency care has developed rapidly during the past decades. The care is given in a complex context which makes prehospital care a potential high-risk activity when it comes to patient safety. Patient safety in the prehospital setting has been only sparsely investigated. The aims of the present study were 1) To investigate the incidence of adverse events (AEs) in prehospital care and 2) To investigate the factors contributing to AEs in prehospital care. Methods We used a retrospective study design where 30 randomly selected prehospital medical records were screened for AEs each month in three prehospital organizations in Sweden during a period of one year. A total of 1080 prehospital medical records were included. The record review was based on the use of 11 screening criteria. Results The reviewers identified 46 AEs in 46 of 1080 (4.3%) prehospital medical records. Of the 46 AEs, 43 were classified as potential for harm (AE1) (4.0, 95% CI = 2.9–5.4) and three as harm identified (AE2) (0.3, 95% CI = 0.1–0.9). However, among patients with a life-threatening condition (priority 1), the risk of AE was higher (16.5%). The most common factors contributing to AEs were deviations from standard of care and missing, incomplete, or unclear documentation. The most common cause of AEs was the result of action(s) or inaction(s) by the emergency medical service (EMS) crew. Conclusions There were 4.3 AEs per 100 ambulance missions in Swedish prehospital care. The majority of AEs originated from deviations from standard of care and incomplete documentation. There was an increase in the risk of AE among patients who the EMS team assessed as having a life-threatening condition. Most AEs were possible to avoid. Electronic supplementary material The online version of this article (10.1186/s12873-019-0228-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magnus Andersson Hagiwara
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
| | - Carl Magnusson
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30, Gothenburg, Sweden
| | - Johan Herlitz
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Elin Seffel
- Department of Ambulance Care, Södra Älvsborg Hospital (SÄS), SE-501 82, Borås, Sweden
| | - Christer Axelsson
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Monica Munters
- Department of Ambulance Care, Region of Dalarna, SE-791 29, Falun, Sweden
| | - Anneli Strömsöe
- School of Health, Care and Social Welfare, Mälardalens högskola, SE-721 23, Västerås, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
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30
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Magnusson C, Axelsson C, Nilsson L, Strömsöe A, Munters M, Herlitz J, Hagiwara MA. The final assessment and its association with field assessment in patients who were transported by the emergency medical service. Scand J Trauma Resusc Emerg Med 2018; 26:111. [PMID: 30587210 PMCID: PMC6307253 DOI: 10.1186/s13049-018-0579-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 12/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background In patients who call for the emergency medical service (EMS), there is a knowledge gap with regard to the final assessment after arriving at hospital and its association with field assessment. Aim In a representative population of patients who call for the EMS, to describe a) the final assessment at hospital discharge and b) the association between the assessment in the field and the assessment at hospital discharge. Methods Thirty randomly selected patients reached by a dispatched ambulance each month between 1 Jan and 31 Dec 2016 in one urban, one rural and one mixed ambulance organisation in Sweden took part in the study. The exclusion criteria were age < 18 years, dead on arrival, transport between health-care facilities and secondary missions. Each patient received a unique code based on the ICD code at hospital discharge and field assessment. Results In all, 1080 patients took part in the study, of which 1076 (99.6%) had a field assessment code. A total of 894 patients (83%) were brought to a hospital and an ICD code (ICD-10-SE) was available in 814 patients (91% of these cases and 76% of all cases included in the study). According to these ICD codes, the most frequent conditions were infection (15%), trauma (15%) and vascular disease (9%). The most frequent body localisation of the condition was the thorax (24%), head (16%) and abdomen (13%). In 118 patients (14% of all ICD codes), the condition according to the ICD code was judged as time critical. Among these cases, field assessment was assessed as potentially appropriate in 75% and potentially inappropriate in 12%. Conclusion Among patients reached by ambulance in Sweden, 83% were transported to hospital and, among them, 14% had a time-critical condition. In these cases, the majority were assessed in the field as potentially appropriate, but 12% had a potentially inappropriate field assessment. The consequences of these findings need to be further explored. Electronic supplementary material The online version of this article (10.1186/s13049-018-0579-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Carl Magnusson
- Department of Molecular and Clinical Medicine, University of Gothenburg and Sahlgrenska University Hospital, SE-405 30, Gothenburg, Sweden
| | - Christer Axelsson
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care and Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden
| | - Anneli Strömsöe
- School of Education, Health and Social Studies, Dalarna University Falun, SE-791 88, Falun, Sweden.,Department of Prehospital Care, County Council of Dalarna, S-79129, Falun, Sweden
| | - Monica Munters
- Department of Ambulance Care, Region of Dalarna, SE-791 29, Falun, Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
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Hansson PO, Andersson Hagiwara M, Brink P, Herlitz J, Wireklint Sundström B. Prehospital identification of factors associated with death during one-year follow-up after acute stroke. Brain Behav 2018; 8:e00987. [PMID: 29770601 PMCID: PMC5991565 DOI: 10.1002/brb3.987] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 03/11/2018] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES In acute stroke, the risk of death and neurological sequelae are obvious threats. The aim of the study was to evaluate the association between various clinical factors identified by the emergency medical service (EMS) system before arriving at hospital and the risk of death during the subsequent year among patients with a confirmed stroke. MATERIAL AND METHODS All patients with a diagnosis of stroke as the primary diagnosis admitted to a hospital in western Sweden (1.6 million inhabitants) during a four-month period were included. There were no exclusion criteria. RESULTS In all, 1,028 patients with a confirmed diagnosis of stroke who used the EMS were included in the analyses. Among these patients, 360 (35%) died during the following year. Factors that were independently associated with an increased risk of death were as follows: (1) high age, per year OR 1.07; 95% CI 1.05-1.09; (2) a history of heart failure, OR 2.08; 95% CI 1.26-3.42; (3) an oxygen saturation of <90%, OR 8.05; 95% CI 3.33-22.64; and (4) a decreased level of consciousness, OR 2.19; 95% CI 1.61-3.03. CONCLUSIONS Among patients with a stroke, four factors identified before arrival at hospital were associated with a risk of death during the following year. They were reflected in the patients' age, previous clinical history, respiratory function, and the function of the central nervous system.
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Affiliation(s)
- Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Andersson Hagiwara
- Faculty of Caring Science, Work Life and Social Welfare, Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Peter Brink
- Department of Health Sciences, Section for nursing - undergraduate level, University West, Trollhättan, Sweden
| | - Johan Herlitz
- Faculty of Caring Science, Work Life and Social Welfare, Centre for Prehospital Research, University of Borås, Borås, Sweden
| | - Birgitta Wireklint Sundström
- Faculty of Caring Science, Work Life and Social Welfare, Centre for Prehospital Research, University of Borås, Borås, Sweden
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Hulldin M, Kängström J, Andersson Hagiwara M, Claesson A. Perceived exertion using two different EMS stretcher systems, report from a Swedish study. Am J Emerg Med 2018; 36:1040-1044. [PMID: 29510910 DOI: 10.1016/j.ajem.2018.02.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/09/2018] [Accepted: 02/24/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Emergency medical services (EMS) facilitate out of hospital care in a wide variety of settings on a daily basis. Stretcher-related adverse events and long term musculoskeletal injuries are commonly reported. Novel stretcher mechanisms may facilitate enhanced movement of patients and reduce workload for EMS personnel. AIM To describe EMS personnel's perceived exertion using two different stretcher systems. METHODS The methodology of this explorative simulation study included enrolling twenty (n=20) registered nurses and paramedics who worked in ten pairs (n=10) to transport a conscious, 165lb. (75kg) patient using two different EMS stretcher systems: the Pensi stretcher labeled A and the ALLFA stretcher labeled B. The ten pairs (n=10) were randomized to use either an A stretcher or a B stretcher with subsequent crossover. The pairs performed six identical tasks with each stretcher, including conveying stretchers from an ambulance up to the first floor of a building via a staircase, loading a patient on to the stretcher, and using the stretcher to transport the patient back to the ambulance. The subjective Rating of Perceived Exertion (RPE) survey (Borg scale) was used to measure perceived exertion at predefined intervals during transport. RESULTS No significant differences in workload were seen between stretcher groups A and B regarding unloading the stretcher (7.4 vs 8.2 p=0.3), transporting up a stairway (13.7 vs 12.5 p=0.06), lateral lift (12.1 vs 11.2 p=0.5), or flat ground transportation (10.4 vs 11.1 p=0.13). Pairs using stretcher A showed significantly less workload with regards to transporting down a stairway (11.0 vs 14.5 p<0.001) and loading into ambulance (11.1 vs 13.0 p<0.001). CONCLUSION A structured methodology may be used for testing the exertion levels experienced while using different stretcher systems. The use of supporting stretcher system mechanisms may reduce perceived exertion in EMS personnel mainly during transports down stairs and during loading into ambulance vehicles.
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Affiliation(s)
- Martin Hulldin
- Southern Älvsborg Emergency Medical Services, SE-501 90 Borås, Sweden
| | - Jonas Kängström
- Southern Älvsborg Emergency Medical Services, SE-501 90 Borås, Sweden
| | - Magnus Andersson Hagiwara
- Southern Älvsborg Emergency Medical Services, SE-501 90 Borås, Sweden; Department of Acute and Prehospital Care and Medical Technology, Prehospen - Center for Prehospital Research and the Prehospital Research Center of Western Sweden, University of Borås, SE-501 90 Borås, Sweden
| | - Andreas Claesson
- Department of Medicine, Center for Resuscitation Science, Karolinska Institute, SE-171 77 Stockholm, Sweden.
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Sterner A, Ramstrand N, Nyström M, Hagiwara MA, Palmér L. Novice nurses' perceptions of acute situations - A phenomenographic study. Int Emerg Nurs 2017; 40:23-28. [PMID: 29269291 DOI: 10.1016/j.ienj.2017.12.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 11/23/2017] [Accepted: 12/02/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Today's nurses face complex patient challenges and increased patient acuity. Novice nurses may feel unprepared for some of the tasks facing them. In order to prevent adverse events and improve patient outcomes, the management of acute situations has been identified as an area needing attention. Despite this, it is not yet clear what novice nurses themselves perceive as an acute situation. Therefore, the aim of this study is to describe novice nurses' perceptions of acute situations. METHOD The study has a qualitative, descriptive design with a phenomenographic approach. Semi-structured interviews were conducted with twelve novice nurses, with less than a year of working experience, about their perceptions of acute situations. RESULTS Acute situations are perceived as situations that occur suddenly, that involve shortage of time, or that generate a sense of insufficient personal competence. When acute situations arise, nurses experience a feeling of overwhelming responsibility. Acute situations involve not only deteriorating patient health but can also include challenging interpersonal relations or deficiencies in organisational procedures. CONCLUSION An acute situation, as perceived by novice nurses, contains significantly more than medical manifestations related to the patient, a prominent perception being that interpersonal relations are crucial for appropriate management.
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Affiliation(s)
- Anders Sterner
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden.
| | - Nerrolyn Ramstrand
- ADULT Research Group, Department of Rehabilitation, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Maria Nyström
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden
| | - Lina Palmér
- Faculty of Caring Sciences, Work Life and Social Welfare, University of Borås, Borås, Sweden
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Wireklint Sundström B, Andersson Hagiwara M, Brink P, Herlitz J, Hansson PO. The early chain of care and risk of death in acute stroke in relation to the priority given at the dispatch centre: A multicentre observational study. Eur J Cardiovasc Nurs 2017; 16:623-631. [PMID: 28417645 DOI: 10.1177/1474515117704617] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The early chain of care is critical for stroke patients. The most important part is the so-called 'system delay' i.e. the delay time from call to the emergency medical services until a diagnosis is established (computer tomography). AIM The purpose of this study was to relate the initial priority level given by the dispatch centre to the early chain of care in acute stroke and to short-term and long-term mortality. METHODS All patients hospitalised with the first and the final diagnosis of acute stroke, 15 December 2010-15 April 2011, were recruited across nine hospitals, each hospital with a stroke care unit. RESULTS In all, 897 stroke patients were included. Priority at the dispatch centre: 54% received highest priority 1, 41% priority 2 and 5% priority 3. Median system delay from call to emergency medical services until diagnosis by computer tomography was 2 h and 52 min, 4 h and 49 min and 6 h and 33 min respectively in the three priority groups ( p<0.0001). There was a similarly strong association between priority level at the dispatch centre and system delay to arrival in a hospital ward, suspicion of stroke by the emergency medical services nurse as well as the physician on hospital admission and the proportion of patients given thrombolysis. Mortality during the subsequent 30 days was 22% among patients with priority 1 and 14% among patients with priority 2. CONCLUSION Patients given a lower priority level at the dispatch centre had the longest system delay. Although many of these patients died, the risk of death was highest among those given the highest priority.
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Affiliation(s)
- Birgitta Wireklint Sundström
- 1 University of Borås, Sweden, PreHospen - Centre for Prehospital Research.,2 University of Borås, Sweden, Faculty of Caring Science, Work Life and Social Welfare
| | - Magnus Andersson Hagiwara
- 1 University of Borås, Sweden, PreHospen - Centre for Prehospital Research.,2 University of Borås, Sweden, Faculty of Caring Science, Work Life and Social Welfare
| | - Peter Brink
- 4 Emergency Medical Service System, NU-Hospital Organisation, Sweden
| | - Johan Herlitz
- 1 University of Borås, Sweden, PreHospen - Centre for Prehospital Research.,2 University of Borås, Sweden, Faculty of Caring Science, Work Life and Social Welfare
| | - Per Olof Hansson
- 3 University of Gothenburg, Sweden, Department of Molecular and Clinical Medicine
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Hagiwara MA, Backlund P, Söderholm HM, Lundberg L, Lebram M, Engström H. Measuring participants' immersion in healthcare simulation: the development of an instrument. Adv Simul (Lond) 2016; 1:17. [PMID: 29449986 PMCID: PMC5806227 DOI: 10.1186/s41077-016-0018-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/21/2016] [Indexed: 12/31/2022] Open
Abstract
Background Immersion is important for simulation-based education; however, questionnaire-based instruments to measure immersion have some limitations. The aim of the present work is to develop a new instrument to measure immersion among participants in healthcare simulation scenarios. Methods The instrument was developed in four phases: trigger identification, content validity scores, inter-rater reliability analysis and comparison with an existing immersion measure instrument. A modified Delphi process was used to develop the instrument and to establish validity and reliability. The expert panel consisted of 10 researchers. All the researchers in the team had previous experience of simulation in the health and/or fire and rescue services as researchers and/or educators and simulation designers. To identify triggers, the panel members independently screened video recordings from simulation scenarios. Here, a trigger is an event in a simulation that is considered a sign of reduced or enhanced immersion among simulation participants. Results The result consists of the Immersion Score Rating Instrument (ISRI). It contains 10 triggers, of which seven indicate reduced and three enhanced immersion. When using ISRI, a rater identifies trigger occurrences and assigns them strength between 1 and 3. The content validity analysis shows that all the 10 triggers meet an acceptable content validity index for items (I-CVI) standard. The inter-rater reliability (IRR) among raters was assessed using a two-way mixed, consistency, average-measures intra-class correlation (ICC). The ICC for the difference between weighted positive and negative triggers was 0.92, which indicates that the raters are in agreement. Comparison with results from an immersion questionnaire mirrors the ISRI results. Conclusions In conclusion, we present a novel and non-intrusive instrument for identifying and rating the level of immersion among participants in healthcare simulation scenarios. Electronic supplementary material The online version of this article (doi:10.1186/s41077-016-0018-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magnus Andersson Hagiwara
- 1Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90 Borås, Sweden
| | - Per Backlund
- 2School of Informatics, University of Skövde, Box 408, 541 28 Skövde, Sweden
| | - Hanna Maurin Söderholm
- 3Centre for Prehospital Research, Swedish School of Library and Information Science, Faculty of Librarianship, Information, Education and IT, University of Borås, 501 90 Borås, Sweden
| | - Lars Lundberg
- 1Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90 Borås, Sweden.,Swedish Armed Forces Centre for Defence Medicine, Box 5155, 426 05 Västra Frölunda, Sweden
| | - Mikael Lebram
- 2School of Informatics, University of Skövde, Box 408, 541 28 Skövde, Sweden
| | - Henrik Engström
- 2School of Informatics, University of Skövde, Box 408, 541 28 Skövde, Sweden
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Engström H, Andersson Hagiwara M, Backlund P, Lebram M, Lundberg L, Johannesson M, Sterner A, Maurin Söderholm H. The impact of contextualization on immersion in healthcare simulation. Adv Simul (Lond) 2016; 1:8. [PMID: 29449977 PMCID: PMC5806259 DOI: 10.1186/s41077-016-0009-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/09/2016] [Indexed: 12/22/2022] Open
Abstract
Background The aim of this paper is to explore how contextualization of a healthcare simulation scenarios impacts immersion, by using a novel objective instrument, the Immersion Score Rating Instrument. This instrument consists of 10 triggers that indicate reduced or enhanced immersion among participants in a simulation scenario. Triggers refer to events such as jumps in time or space (sign of reduced immersion) and natural interaction with the manikin (sign of enhanced immersion) and can be used to calculate an immersion score. Methods An experiment using a randomized controlled crossover design was conducted to compare immersion between two simulation training conditions for prehospital care: one basic and one contextualized. The Immersion Score Rating Instrument was used to compare the total immersion score for the whole scenario, the immersion score for individual mission phases, and to analyze differences in trigger occurrences. A paired t test was used to test for significance. Results The comparison shows that the overall immersion score for the simulation was higher in the contextualized condition. The average immersion score was 2.17 (sd = 1.67) in the contextualized condition and -0.77 (sd = 2.01) in the basic condition (p < .001). The immersion score was significantly higher in the contextualized condition in five out of six mission phases. Events that might be disruptive for the simulation participants' immersion, such as interventions of the instructor and illogical jumps in time or space, are present to a higher degree in the basic scenario condition; while events that signal enhanced immersion, such as natural interaction with the manikin, are more frequently observed in the contextualized condition. Conclusions The results suggest that contextualization of simulation training with respect to increased equipment and environmental fidelity as well as functional task alignment might affect immersion positively and thus contribute to an improved training experience.
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Affiliation(s)
- Henrik Engström
- 1School of Informatics, University of Skövde, Box 408, 541 28 Skövde, Sweden
| | - Magnus Andersson Hagiwara
- 2Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90 Borås, Sweden
| | - Per Backlund
- 1School of Informatics, University of Skövde, Box 408, 541 28 Skövde, Sweden
| | - Mikael Lebram
- 1School of Informatics, University of Skövde, Box 408, 541 28 Skövde, Sweden
| | - Lars Lundberg
- 2Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90 Borås, Sweden.,Swedish Armed Forces Centre for Defence Medicine, Box 5155, 426 05 Västra Frölunda, Sweden
| | - Mikael Johannesson
- 1School of Informatics, University of Skövde, Box 408, 541 28 Skövde, Sweden
| | - Anders Sterner
- 2Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, 501 90 Borås, Sweden
| | - Hanna Maurin Söderholm
- 4Centre for Prehospital Research, Swedish School of Library and Information Science, Faculty of Librarianship, Information, Education and IT, University of Borås, 501 90 Borås, Sweden
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Hagiwara MA, Nilsson L, Strömsöe A, Axelsson C, Kängström A, Herlitz J. Patient safety and patient assessment in pre-hospital care: a study protocol. Scand J Trauma Resusc Emerg Med 2016; 24:14. [PMID: 26868416 PMCID: PMC4751749 DOI: 10.1186/s13049-016-0206-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 02/02/2016] [Indexed: 12/02/2022] Open
Abstract
Background Patient safety issues in pre-hospital care are poorly investigated. The aim of the planned study is to survey patient safety problems in pre-hospital care in Sweden. Methods/Design The study is a retro-perspective structured medical record review based on the use of 11 screening criteria. Two instruments for structured medical record review are used: a trigger tool instrument designed for pre-hospital care and a newly development instrument designed to compare the pre-hospital assessment with the final hospital assessment. Three different ambulance organisations are participating in the study. Every month, one rater in each organisation randomly collects 30 medical records for review. With guidance from the review instrument, he/she independently reviews the record. Every month, the review team meet for a discussion of problematic reviews. The results will be analysed with descriptive statistics and logistic regression. Discussion The findings will make an important contribution to knowledge about patient safety issues in pre-hospital care.
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Affiliation(s)
- Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
| | - Lena Nilsson
- Department of Anaesthesiology and Intensive Care, Linköping University, SE-581 85, Linköping, Sweden. .,Department of Medical and Health Sciences, Linköping University, SE-581 85, Linköping, Sweden.
| | - Anneli Strömsöe
- School of Health, Care and Social Welfare, Mälardalens högskola, Box 883, SE-721 23, Västerås, Sweden.
| | - Christer Axelsson
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
| | - Anna Kängström
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden. anna.kangstrom.@hb.se
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden.
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Hagiwara MA, Bremer A, Claesson A, Axelsson C, Norberg G, Herlitz J. The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis. Scand J Trauma Resusc Emerg Med 2014; 22:67. [PMID: 25420752 PMCID: PMC4258278 DOI: 10.1186/s13049-014-0067-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/27/2014] [Indexed: 11/10/2022] Open
Abstract
Background For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome. Methods Databases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages. The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality. Results Median delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes. In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%. Conclusion An overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway. Electronic supplementary material The online version of this article (doi:10.1186/s13049-014-0067-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Magnus Andersson Hagiwara
- School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden.
| | - Anders Bremer
- School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden.
| | - Andreas Claesson
- School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden.
| | - Christer Axelsson
- School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden.
| | - Gabriella Norberg
- School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden.
| | - Johan Herlitz
- School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden. .,Inst of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden.
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Andersson Hagiwara M, Suserud BO, Andersson-Gäre B, Sjöqvist BA, Henricson M, Jonsson A. The effect of a Computerised Decision Support System (CDSS) on compliance with the prehospital assessment process: results of an interrupted time-series study. BMC Med Inform Decis Mak 2014; 14:70. [PMID: 25106732 PMCID: PMC4136405 DOI: 10.1186/1472-6947-14-70] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 08/06/2014] [Indexed: 11/29/2022] Open
Abstract
Background Errors in the decision-making process are probably the main threat to patient safety in the prehospital setting. The reason can be the change of focus in prehospital care from the traditional “scoop and run” practice to a more complex assessment and this new focus imposes real demands on clinical judgment. The use of Clinical Guidelines (CG) is a common strategy for cognitively supporting the prehospital providers. However, there are studies that suggest that the compliance with CG in some cases is low in the prehospital setting. One possible way to increase compliance with guidelines could be to introduce guidelines in a Computerized Decision Support System (CDSS). There is limited evidence relating to the effect of CDSS in a prehospital setting. The present study aimed to evaluate the effect of CDSS on compliance with the basic assessment process described in the prehospital CG and the effect of On Scene Time (OST). Methods In this time-series study, data from prehospital medical records were collected on a weekly basis during the study period. Medical records were rated with the guidance of a rating protocol and data on OST were collected. The difference between baseline and the intervention period was assessed by a segmented regression. Results In this study, 371 patients were included. Compliance with the assessment process described in the prehospital CG was stable during the baseline period. Following the introduction of the CDSS, compliance rose significantly. The post-intervention slope was stable. The CDSS had no significant effect on OST. Conclusions The use of CDSS in prehospital care has the ability to increase compliance with the assessment process of patients with a medical emergency. This study was unable to demonstrate any effects of OST.
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Hagiwara MA, Suserud BO, Jonsson A, Henricson M. Exclusion of context knowledge in the development of prehospital guidelines: results produced by realistic evaluation. Scand J Trauma Resusc Emerg Med 2013; 21:46. [PMID: 23799944 PMCID: PMC3699357 DOI: 10.1186/1757-7241-21-46] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 06/16/2013] [Indexed: 11/10/2022] Open
Abstract
Background Prehospital work is accomplished using guidelines and protocols, but there is evidence suggesting that compliance with guidelines is sometimes low in the prehospital setting. The reason for the poor compliance is not known. The objective of this study was to describe how guidelines and protocols are used in the prehospital context. Methods This was a single-case study with realistic evaluation as a methodological framework. The study took place in an ambulance organization in Sweden. The data collection was divided into four phases, where phase one consisted of a literature screening and selection of a theoretical framework. In phase two, semi-structured interviews with the ambulance organization's stakeholders, responsible for the development and implementation of guidelines, were performed. The third phase, observations, comprised 30 participants from both a rural and an urban ambulance station. In the last phase, two focus group interviews were performed. A template analysis style of documents, interviews and observation protocols was used. Results The development of guidelines took place using an informal consensus approach, where no party from the end users was represented. The development process resulted in guidelines with an insufficiently adapted format for the prehospital context. At local level, there was a conscious implementation strategy with lectures and manikin simulation. The physical format of the guidelines was the main obstacle to explicit use. Due to the format, the ambulance personnel feel they have to learn the content of the guidelines by heart. Explicit use of the guidelines in the assessment of patients was uncommon. Many ambulance personnel developed homemade guidelines in both electronic and paper format. The ambulance personnel in the study generally took a positive view of working with guidelines and protocols and they regarded them as indispensable in prehospital care, but an improved format was requested by both representatives of the organization and the ambulance personnel. Conclusions The personnel take a positive view of the use of guidelines and protocols in prehospital work. The main obstacle to the use of guidelines and protocols in this organization is the format, due to the exclusion of context knowledge in the development process.
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