| 1. |
- Bergman, Lina, 1985, et al.
(författare)
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Development and initial psychometric testing of the Intrahospital Transport Safety Scale in intensive care
- 2020
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Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 10
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Tidskriftsartikel (refereegranskat)abstract
- Objective To develop and evaluate the psychometric properties of a scale measuring patient safety during the intrahospital transport process for intensive care. Design The scale was developed based on a theoretical model of the work system and patient safety, and items generated from participant observations. A Delphi study with international experts was used to establish content validity. Next, a cross-sectional study was undertaken to inform item reduction and evaluate construct validity and internal consistency. Setting The questionnaire was distributed to healthcare practitioners at 12 intensive care units in Sweden. Participants A total of 315 questionnaires were completed. Eligible participants were healthcare practitioners in the included units that performed an intrahospital transport during the study period. Inclusion criteria were (1) transports of patients within the hospital to undergo an examination or intervention, and (2) transports performed by staff from the intensive care unit. We excluded transports to a step-down unit or hospital ward. Outcome measures Psychometric evaluation, including item analysis, validity and reliability testing. Results Items were reduced from 55 to 24, informed by distributional statistics, initial reliabilities, factor loadings and communalities. The final factor model consisted of five factors, accounting for 59% of variance. All items loaded significantly on only one factor (>0.35). The original conceptual model of teamwork, transport-related tasks, tools and technologies, environment, and organisation was maintained with regrouping of items. Cronbach's alpha ranged from 0.72 to 0.82 for each subscale (ie, factor). Conclusions The present study provides a self-report questionnaire to assess patient safety during intrahospital transport of patients in intensive care. The results indicate acceptable validity and reliability of the scale among a sample of Swedish healthcare practitioners. If further confirmatory testing supports the present results, this scale could be a useful tool to better understand safety prerequisites and improve clinical practice.
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| 2. |
- Bergman, Lina, 1985, et al.
(författare)
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Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study.
- 2020
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Ingår i: Australian critical care : official journal of the Confederation of Australian Critical Care Nurses. - : Elsevier BV. - 1036-7314. ; 33:1, s. 12-19
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Tidskriftsartikel (refereegranskat)abstract
- Intrahospital transport is a high-risk procedure for critically ill patients, yet there is little known about how the transport team manages critical incidents that occur.The aim of this study was to explore critical care nurses' and physicians' experiences and practices associated with critical incidents during the transfer process in critically ill patients.As a part of an ethnographic study, semistructured interviews were performed using the critical incident technique. Data were collected in two intensive care units at one university hospital in a Swedish metropolitan city. Critical care nurses (n=15) and physicians (n=5) were interviewed, together describing a total of 46 critical incidents. Data were analysed using qualitative content and thematic analysis approaches.Content analysis of nurses' and physicians' practices resulted in a description of requirements for safe transports, including organisational prerequisites, professional skills and attributes, as well as actions and behaviours of safely performing transfers. Exploring the experiences of nurses and physicians in transporting critically ill patients yielded three main themes. The first theme, a hazardous process, revealed how caring for critically ill patients during intrahospital transfers was perceived as an unsafe, demanding task that presents several threats to the patient's safety. However, despite worries and concerns, participants trusted their own abilities to handle unexpected events, resulting in the second theme, performing when it matters. The third theme, towards safe practice, captured suggestions for improvement and attitudes towards existing safety hazards.To prevent and manage critical incidents during intrahospital transport, findings of this study suggest that nontechnical skillssuch as situational awareness and teamworkare essential. In addition, the team must possess the requisite technical skills and knowledge to undertake transports. Finally, organisations are required to provide a supportive and sustainable transport environment that includes fewer transport-related hazards.
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| 3. |
- Bergman, Lina, 1985, et al.
(författare)
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In safe hands: Patients' experiences of intrahospital transport during intensive care
- 2020
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Ingår i: Intensive and Critical Care Nursing. - : Elsevier BV. - 0964-3397. ; 59:August
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Intrahospital transports are associated with complications and adverse events in intensive care patients. Yet, little is known about how patients' percive these tranfers. Thus, this study aimed to explore patients' experiences of the intrahospital transport process. Research Design: An exploratory qualitative study compromising interviews with twelve patients. Data were analysed using thematic analysis. Setting: Two intensive care units in a university hospital setting. Main Outcome: An understanding of patients' experiences of the intrahospital transport process. Findings: The main finding was patients' description of "being in safe hands" during the transport. Patients' experience of transports as feasible and safe was reflected in the first main theme, "feeling prepared and safeguarded". The second theme, "being on the move", described patients' perceptions of the transport; although they were aware of movement, the transport was viewed as a minor event during their stay. The third theme, "entrusting myself to others", revealed how patients handed over control and decision making to the staff, confident that they would look after their best interest. Conclusions: Patients perceived intrahospital transports as an acceptable and safe process. Findings suggest that patients' experience could be improved by being provided with accurate and timely information and preparedness for transport-related events. (C) 2020 Elsevier Ltd. All rights reserved.
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| 4. |
- Bergman, Lina, 1985, et al.
(författare)
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Multi-Fetal Pregnancy, Preeclampsia, and Long-Term Cardiovascular Disease
- 2020
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Ingår i: Hypertension. - : Ovid Technologies (Wolters Kluwer Health). - 0194-911X .- 1524-4563. ; 76:1, s. 167-175
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Tidskriftsartikel (refereegranskat)abstract
- This Swedish register-based cohort study determined the separate and joint contribution of preeclampsia and multi-fetal pregnancy on a woman's risk of cardiovascular disease (CVD) later in life. The study included 892 425 first deliveries between 1973 and 2010 of women born 1950 until 1971, identified in the Swedish Medical Birth Register. A composite outcome of CVD was retrieved through linkage with the National Patient and Cause of Death Registers. Cox proportional hazard regression was used to assess the risk of CVD in women who had preeclampsia in a singleton or multi-fetal pregnancy, adjusting for potential confounders, and presented as adjusted hazard ratios. Compared with women who had a singleton pregnancy without preeclampsia (the referent group), women with preeclampsia in a singleton pregnancy had an increased risk of CVD (adjusted hazard ratio 1.75 [95% CI, 1.64-1.86]). Women who had a multi-fetal pregnancy without or with preeclampsia did not have an increased risk of future CVD (adjusted hazard ratios 0.94 [95% CI, 0.79-1.10] and 1.25 [95% CI, 0.83-1.86], respectively). As opposed to preeclampsia in a first singleton pregnancy, preeclampsia in a first multi-fetal pregnancy was not associated with increased risk of future CVD. This may support the theory that preeclampsia in multi-fetal pregnancies more often occurs as a result of the larger pregnancy-related burden on the maternal cardiovascular system and excessive placenta-shed inflammatory factors, rather than the woman's underlying cardiovascular phenotype.
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| 5. |
- Bergman, Lina, 1985
(författare)
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Patient safety during intrahospital transports in intensive care. Hazards, experiences and future measurements
- 2020
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patient safety is an attribute of the healthcare system that minimizes the incidence of adverse events (AEs), and that entails identifying the causes of harm and preventive strategies. Intrahospital transport (IHT) of patients in intensive care is a process associated with AEs and patient complications. Despite this, little is known about how contextual, organizational and human factors influence patient safety during the IHT process. The overall aim of this thesis was therefore to explore patient safety during the IHT process in intensive care. An ethnographical study was conducted, including participant observations (Study I) and interviews with healthcare professionals and patients (Studies II and III). Furthermore, a cross-sectional study was undertaken to develop and evaluate a scale to measure patient safety during IHTs (Study IV). The findings in this thesis show that the structure of the healthcare system influenced the IHT process. System deficiencies included lack of resources, insufficient transport equipment and poor hospital and workplace design. Teamwork during IHTs was characterized by high team member turnover, unclear team roles and, sometimes, limited communication and cooperation. Task performance was demanding and affected by disturbances and interruptions. Identified skills for safe IHT included knowledge of IHT-related tasks and teamwork, as well as anticipating and preparing for potential patient safety threats. Patients felt safe during the IHT because they trusted the staff to look after their interests. However, safety hazards were common, albeit seldom resulting in harm to patients. The development of the IHT safety scale resulted in a 24-item instrument. The study yielded evidence of construct validity and internal consistency reliability in a sample of Swedish healthcare practitioners. The conclusion in this thesis is that IHTs of intensive care patients are hazardous, complex and demanding. Despite the existence of system deficiencies, adverse incidents (AIs) are often handled correctly; few patients thus seem to suffer AEs. The findings suggest that safety improvements should aim to (re)design systems that meet the requirements for performing transfers safely, and that the issue of how clinicians’ resilience capacity can be supported should also be taken into consideration. The IHT safety scale could be a useful tool to better understand safety prerequisites and improve clinical practice.
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| 7. |
- Bergman, Lina, 1985, et al.
(författare)
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Safety Hazards During Intrahospital Transport: A Prospective Observational Study.
- 2017
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Ingår i: Critical care medicine. - 1530-0293. ; 45:10
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Tidskriftsartikel (refereegranskat)abstract
- To identify, classify, and describe safety hazards during the process of intrahospital transport of critically ill patients.A prospective observational study. Data from participant observations of the intrahospital transport process were collected over a period of 3 months.The study was undertaken at two ICUs in one university hospital.Critically ill patients transported within the hospital by critical care nurses, unlicensed nurses, and physicians.None.Content analysis was performed using deductive and inductive approaches. We detected a total of 365 safety hazards (median, 7; interquartile range, 4-10) during 51 intrahospital transports of critically ill patients, 80% of whom were mechanically ventilated. The majority of detected safety hazards were assessed as increasing the risk of harm, compromising patient safety (n = 204). Using the System Engineering Initiative for Patient Safety, we identified safety hazards related to the work system, as follows: team (n = 61), tasks (n = 83), tools and technologies (n = 124), environment (n = 48), and organization (n = 49). Inductive analysis provided an in-depth description of those safety hazards, contributing factors, and process-related outcomes.Findings suggest that intrahospital transport is a hazardous process for critically ill patients. We have identified several factors that may contribute to transport-related adverse events, which will provide the opportunity for the redesign of systems to enhance patient safety.
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