| 31. |
- Valaker, Irene, et al.
(författare)
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Continuity of care and its associations with self-reported health, clinical characteristics and follow-up services after percutaneous coronary intervention
- 2020
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Ingår i: BMC Health Services Research. - : BioMed Central. - 1472-6963. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Complexity of care in patients with coronary artery disease is increasing, due to ageing, improved treatment, and more specialised care. Patients receive care from various healthcare providers in many settings. Still, few studies have evaluated continuity of care across primary and secondary care levels for patients after percutaneous coronary intervention (PCI). This study aimed to determine multifaceted aspects of continuity of care and associations with socio-demographic characteristics, self-reported health, clinical characteristics and follow-up services for patients after PCI. Methods: This multi-centre prospective cohort study collected data at baseline and two-month follow-up from medical records, national registries and patient self-reports. Univariable and hierarchical regressions were performed using the Heart Continuity of Care Questionnaire total score as the dependent variable. Results: In total, 1695 patients were included at baseline, and 1318 (78%) completed the two-month follow-up. Patients stated not being adequately informed about lifestyle changes, medication and follow-up care. Those experiencing poorer health status after PCI scored significantly worse on continuity of care. Patients with ST-segment elevation myocardial infarction scored significantly better on informational and management continuity than those with other cardiac diagnoses. The regression analyses showed significantly better continuity (P <= 0.034) in patients who were male, received written information from hospital, were transferred to another hospital before discharge, received follow-up from their general practitioner or had sufficient consultation time after discharge from hospital. Conclusion: Risk factors for sub-optimal continuity were identified. These factors are important to patients, healthcare providers and policy makers. Action should be taken to educate patients, reconcile discharge plans and organise post-discharge services. Designing pathways with an interdisciplinary approach and shared responsibility between healthcare settings is recommended.
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| 32. |
- Wallin, Kim, Doktorand, 1978-, et al.
(författare)
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The ways specialist nursing students understand the work in the ambulance service - a national Swedish phenomenographic study
- 2022
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Ingår i: International Journal of Qualitative Studies on Health and Well-being. - : Taylor & Francis Group. - 1748-2623 .- 1748-2631. ; 17:1
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Tidskriftsartikel (refereegranskat)abstract
- ObjectiveTo explore and describe the ways specialist ambulance nursing (SAN) students understand the work in the ambulance service.Design, sample, and measurementsAn explorative descriptive design was carried out through individual interviews with 16 SAN students from all parts of Sweden and analysed in accordance with the phenomenographic tradition.FindingsFive different ways of understanding the work were described and each was assigned a metaphor; The medical role; The practical role; The patient-oriented role; The commanding role; and The comprehensive role. Several aspects concerning personal, organizational, and situational conditions affecting the understanding and the distribution of these roles in the specific care assignment were identified and presented in a hierarchical model of the outcome space.ConclusionsThis study contributes with a new perspective on supporting role clarity for registered nurses (RN) working in the ambulance service (AS). Specialization and experiential learning are needed to support an understanding of all aspects of the work in order to develop a professional competence aligned with the challenges faced in the AS. The development of expertise in the AS needs a contextualized understanding rooted in a theoretical framework that addresses a holistic perspective towards patients’ needs.
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| 33. |
- Wennman, Ingela, et al.
(författare)
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Actions taken affecting lead time in the care pathway for low-priority patients with a suspected stroke: A critical incident study
- 2022
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Ingår i: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 60
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Tidskriftsartikel (refereegranskat)abstract
- Background: The time delay from alerted ambulance to arrival at the stroke unit is crucial for patients suffering a suspected stroke. This is a recognized problem why additional explorative knowledge regarding actions taken are needed. Aim: To explore actions taken by nurses that affect lead times in the care pathway from the alerted ambulance to the stroke unit, for low-priority patients suffering a suspected stroke. Method: The design of the study was explorative and descriptive and used a qualitative approach based on Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care pathway at an university hospital in western Sweden were interviewed about their actions that affected the lead time. Results: Actions undertaken affected lead time in the stroke care pathway for low-priority patients related to “promoting the care chain process” and “taking control of the situation”. Conclusions: The staff within all parts of the care pathway affected the lead time, individually as well as via interaction between departments. This calls for the need of further collaboration and consensus concerning how to facilitate a smooth care pathway.
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| 34. |
- Wennman, Ingela, et al.
(författare)
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Experienced critical incidents affecting lead-times in the stroke care chain for low-priority patients - A qualitative study with critical incident technique
- 2021
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Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 58
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The time elapsing from the alarm being raised to arrival at the stroke unit is crucial for patients suffering a conceivable stroke. More knowledge is needed about critical incidents-both favourable and unfavourable-affecting the lead time in the care chain.AIM: To explore favourable and unfavourable critical incidents (CIs), affecting lead times in the care chain from the alerted ambulance to the stroke unit, as experienced by nurses, for low-priority patients suffering a conceivable acute stroke.METHOD: The study had an explorative descriptive design using a qualitative approach of Flanagan's Critical Incident Technique (CIT). Twenty-two nurses involved in the stroke care chain at a hospital in western Sweden were interviewed about their experiences regarding CIs influencing the lead time for low-priority patients.RESULTS: There were 363 CIs identified related to human interactions and organizational structures. The types of CIs varied depending on where in the care chain they were experienced. Both favourable and unfavourable factors had an impact on the length of the lead time from alerted ambulance to stroke unit for lowpriority patients. Furthermore, CIs occurring both early and later in the care chain affected the whole process.CONCLUSIONS: There is a need for greater understanding within each interrelated department in the care chain about how CIs at one part of the care chain have an impact on another.
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| 35. |
- Wennman, Ingela, et al.
(författare)
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Fast track to stroke unit for patients not eligible for acute intervention, a case-control register study on 1066 patients.
- 2023
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Ingår i: Scientific reports. - : Springer Nature. - 2045-2322. ; 13:1
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Tidskriftsartikel (refereegranskat)abstract
- Stroke patients not eligible for acute intervention often have low priority and may spend long time at the emergency department (ED) waiting for admission. The aim of this retrospective case-control register study was to evaluate outcomes for such "low priority" stroke patients who were transported via Fast Track directly to the stroke unit, according to pre-specified criteria by emergency medical service (EMS). The outcomes of Fast Track patients, transported directly to stroke unit (cases) were compared with the outcomes of patients who fulfilled these critera for Fast Track, but instead were transported to the ED (controls). In all, 557 cases and 509 controls were identified. The latter spent a mean time of 237 min in the ED before admission. The 90-day mortality rate was 12.9% for cases and 14.7% for controls (n.s.). None of the secondary outcome events differed significantly between the groups: 28-day mortality rate; death rate during hospitalisation; proportion of pneumonias, falls or pressure ulcers; or health-related outcomes according to the EQ-5D-5L questionnaire. These findings indicates that the Fast Track to the stroke unit by an EMS is safe for selected stroke patients and could avoid non-valuable time in the ED.
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| 36. |
- Wireklint, Sara, et al.
(författare)
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A longitudinal, retrospective registry-based validation study of RETTS(©), the Swedish adult ED context version
- 2022
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : BioMed Central (BMC). - 1757-7241. ; 30:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Triage and triage related work has been performed in Swedish Emergency Departments (EDs) since the mid-1990s. The Rapid Emergency Triage and Treatment System (RETTS(©)), with annual updates, is the most applied triage system. However, the national implementation has been performed despite low scientific foundation for triage as a method, mainly related to the absence of adjustment to age and gender. Furthermore, there is a lack of studies of RETTS(©) in Swedish ED context, especially of RETTS(©) validity. Hence, the aim the study was to determine the validity of RETTS(©). Methods: A longitudinal retrospective register study based on cohort data from a healthcare region comprising two EDs in southern Sweden. Two editions of RETTS(©) was selected; year 2013 and 2016, enabling comparison of crude data, and adjusted for age-combined Charlson comorbidity index (ACCI) and gender. All patients >= 18 years visiting either of the two EDs seeing a physician, was included. Primary outcome was ten-day mortality, secondary outcome was admission to Intensive Care Unit (ICU). The data was analysed with descriptive, and inferential statistics. Results: Totally 74,845 patients were included. There was an increase in patients allocated red or orange triage levels (unstable) between the years, but a decrease of admission, both to general ward and ICU. Of all patients, 1031 (1.4%) died within ten-days. Both cohorts demonstrated a statistically significant difference between the triage levels, i.e. a higher risk for ten-day mortality and ICU admission for patients in all triage levels compared to those in green triage level. Furthermore, significant statistically differences were demonstrated for ICU admission, crude as well as adjusted, and for adjusted data ten-day mortality, indicating that ACCI explained ten-day mortality, but not ICU admission. However, no statistically significant difference was found for the two annual editions of RETTS(©) considering ten-day mortality, crude data. Conclusion: The annual upgrade of RETTS(©) had no statistically significant impact on the validity of the triage system, considering the risk for ten-day mortality. However, the inclusion of ACCI, or at least age, can improve the validity of the triage system.
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