| 1. |
- Bachnick, Stefanie, et al.
(författare)
-
TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) Project : Protocol for an International Longitudinal Multicenter Study
- 2024
-
Ingår i: JMIR Research Protocols. - 1929-0748. ; 13
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Nursing-sensitive events (NSEs) are common, accounting for up to 77% of adverse events in hospitalized patients (eg, fall-related harm, pressure ulcers, and health care-associated infections). NSEs lead to adverse patient outcomes and impose an economic burden on hospitals due to increased medical costs through a prolonged hospital stay and additional medical procedures. To reduce NSEs and ensure high-quality nursing care, appropriate nurse staffing levels are needed. Although the link between nurse staffing and NSEs has been described in many studies, appropriate nurse staffing levels are lacking. Existing studies describe constant staffing exposure at the unit or hospital level without assessing patient-level exposure to nurse staffing during the hospital stay. Few studies have assessed nurse staffing and patient outcomes using a single-center longitudinal design, with limited generalizability. There is a need for multicenter longitudinal studies with improved potential for generalizing the association between individual nurse staffing levels and NSEs.OBJECTIVE: This study aimed (1) to determine the prevalence, preventability, type, and severity of NSEs; (2) to describe individual patient-level nurse staffing exposure across hospitals; (3) to assess the effect of nurse staffing on NSEs in patients; and (4) to identify thresholds of safe nurse staffing levels and test them against NSEs in hospitalized patients.METHODS: This international multicenter study uses a longitudinal and observational research design; it involves 4 countries (Switzerland, Sweden, Germany, and Iran), with participation from 14 hospitals and 61 medical, surgery, and mixed units. The 16-week observation period will collect NSEs using systematic retrospective record reviews. A total of 3680 patient admissions will be reviewed, with 60 randomly selected admissions per unit. To be included, patients must have been hospitalized for at least 48 hours. Nurse staffing data (ie, the number of nurses and their education level) will be collected daily for each shift to assess the association between NSEs and individual nurse staffing levels. Additionally, hospital data (ie, type, teaching status, and ownership) and unit data (ie, service line and number of beds) will be collected.RESULTS: As of January 2024, the verification process for the plausibility and comprehensibility of patients' and nurse staffing data is underway across all 4 countries. Data analyses are planned to be completed by spring 2024, with the first results expected to be published in late 2024.CONCLUSIONS: This study will provide comprehensive information on NSEs, including their prevalence, preventability, type, and severity, across countries. Moreover, it seeks to enhance understanding of NSE mechanisms and the potential impact of nurse staffing on these events. We will evaluate within- and between-hospital variability to identify productive strategies to ensure safe nurse staffing levels, thereby reducing NSEs in hospitalized patients. The TAILR (Nursing-Sensitive Events and Their Association With Individual Nurse Staffing Levels) study will focus on the optimization of scarce staffing resources.INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56262.
|
|
| 2. |
- Chammout, Ghazi, et al.
(författare)
-
HOPE-Trial: Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians : A Randomized Controlled Trial
- 2019
-
Ingår i: JB & JS open access. - : The Journal of Bone and Joint Surgery. - 2472-7245. ; 4:2
-
Tidskriftsartikel (refereegranskat)abstract
- Background: The choice of primary hemiarthroplasty or total hip arthroplasty in patients ≥80 years of age with a displaced femoral neck fracture has not been adequately studied. As the number of healthy, elderly patients ≥80 years of ageis continually increasing, optimizing treatments for improving outcomes and reducing the need for secondary surgery is an important consideration. The aim of the present study was to compare the results of hemiarthroplasty with those of totalhip arthroplasty in patients ≥80 years of age.Methods: This prospective, randomized, single-blinded trial included 120 patients with a mean age of 86 years (range, 80 to 94 years) who had sustained an acute displaced femoral neck fracture <36 hours previously. The patients were randomized to treatment with hemiarthroplasty (n = 60) or total hip arthroplasty (n = 60). The primary end points were hip function and health-related quality of life at 2 years. Secondary end points included hip-related complications and reoperations, mortality, pain in the involved hip, activities of daily living, surgical time, blood loss, and general complications.The patients were reviewed at 3 months and 1 and 2 years.Results: We found no differences between the groups in terms of hip function, health-related quality of life, hip-related complications and reoperations, activities of daily living, or pain in the involved hip. Hip function, activities of daily living,and pain in the involved hip deteriorated in both groups compared with pre-fracture values. The ability to regain previous walking function was similar in both groups.Conclusions: We found no difference in outcomes after treatment with either hemiarthroplasty or total hip arthroplasty inactive octogenarians and nonagenarians with a displaced femoral neck fracture up to 2 years after surgery. Hemiarthroplastyis a suitable procedure in the short term for this group of patients.Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
|
|
| 3. |
- Chammout, Ghazi, et al.
(författare)
-
Primary hemiarthroplasty for the elderly patient with cognitive dysfunction and a displaced femoral neck fracture : a prospective, observational cohort study
- 2021
-
Ingår i: Aging Clinical and Experimental Research. - : Springer. - 1594-0667 .- 1720-8319. ; 33:5, s. 1275-1283
-
Tidskriftsartikel (refereegranskat)abstract
- Background: At least one-third of hip fracture patients have some degree of impaired cognitive status, which may complicate their postoperative rehabilitation.Aim: We aimed to describe the outcome for elderly patients with cognitive dysfunction operated with hemiarthroplasty (HA) for a femoral neck fracture and to study the impact postoperative geriatric rehabilitation has on functional outcome up to 1 year after surgery.Methods: 98 patients with a displaced femoral neck fracture with a mean age of 86 years were included and followed up to 1 year. The outcomes were hip-related complications and reoperations, the capacity to return to previous walking ability, health-related quality of life, hip function and mortality.Results: The prevalence of hip complications leading to a major reoperation was 6% and the 1-year mortality rate was 31%. The lack of geriatric rehabilitation was correlated with poorer outcomes overall and those who receive geriatric rehabilitation were less likely to be confined to a wheelchair or bedridden at the 1-year follow-up.Conclusions: Hemiarthroplasty is an acceptable option for elderly patients with a displaced femoral neck fracture and cognitive dysfunction. A lack of structured rehabilitation is associated with a significant deterioration in walking ability despite a well-functioning hip. However, the causality of this could be due to selection bias of healthier patients being sent to geriatric rehabilitation.
|
|
| 4. |
- Kelly-Pettersson, Paula
(författare)
-
Improving the quality of care for hip fracture patients : studies on fast-track to surgery and adverse events
- 2018
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Hip fractures in the elderly are common and are associated with high comorbidity and mortality. Their care and treatment present challenges for nurses and other healthcare professionals and impose a substantial burden on healthcare resources. The general aim of this thesis was to examine how a new enhanced fast-track system to operation, waiting time to surgery, and depression influence outcomes in patients after hip fracture, with particular interest in adverse events. In study I, we examined the effects of the implementation of a new enhanced fast-tracking system for the management of hip-fracture patients compared to an already existing system in 415 patients. Data was collected prospectively and a record review was carried out. Our results showed that the time to surgery was reduced by an average of 3 hours in patients admitted via the new fast-track system compared to the existing system. We found no difference in the 3-month mortality or the length of stay (LOS) between the groups. There was a trend toward a lower incidence of adverse events (AEs) in the invention group at 3 months, but this difference did not reach statistical significance. We were able to show that the introduction of an enhanced fast-track management system to surgery could reduce waiting time to surgery for this patient group. In study II, we investigated how waiting time to surgery influenced the risk of serious adverse advents (SAEs) in patients with hip fracture and how time affected risk. A retrospective record review was conducted. Outcomes were the occurrence of SAEs, the LOS and one-year mortality rate. A cohort of 576 patients was included (577 hip fractures) in the study. We found that around 20.6% suffered at least one SAE during the hospital stay (range 1-5). Risk of SAE increased by 12% with every 10 hours of waiting time and the length of the hospital stay was prolonged by 0.6 days with every 24 hours of waiting time to operation. No optimal cut-off times for waiting time to surgery were found and no correlation between waiting time to surgery and one-year mortality. Those patients at greatest risk of SAEs were patients with pre-existing health problems, males and those with subtrochanteric fractures. In study III we explored the incidence, preventability and nature of adverse events occurring in hip-fracture patients up to 90 days after surgery. A structured retrospective record review, using the Swedish version of Global Trigger Tool methodology was carried out on prospectively collected data from 163 patients. Sixty-two of the patients (38%) suffered at least one AE during their hospital stay and up to 90 days post-operatively (range 1-7). The most common types of AEs were infections such as pneumonia and urinary tract infections, but pressure ulcers and AEs associated with surgery were also common. AEs were more common in older patients and those with pre-existing health conditions. About 60% of these AEs were judged to be preventable. In study IV, we investigated the influence of depression on patient-reported outcome up to one year after hip fracture. A cohort of 162 patients with intact cognitive function were included into either the depression or control group and were followed from baseline, to 3- months and 12-months. Using questionnaires, patients reported on their pain levels, hip function and quality of life. The depression group had significantly poorer hip function at baseline but this had improved at 3-months. The depression group experienced a lower health-related quality of life at baseline compared to the control group. At 12 months, neither group had returned to their pre-fracture level of function. Both groups experienced a decline in their health-related quality of life. The one-year mortality rate was higher in the depression group compared to the control group but the difference was not statistically significant. In this study we did not find that depression had a bearing on patient-reported outcome one year after hip fracture in patients without cognitive impairment. In conclusion, the results of these studies demonstrate that the introduction of a new fast-track can reduce waiting time to surgery. Long waiting time to surgery is correlated with increased risk for SAEs and prolonged hospital stay. No optimal cut-off times exist, the risk for SAEs increases linearly over time. Patients at greatest risk of suffering SAEs are those with a higher American Society of Anaethesiologist’s (ASA) classification score, males and those with subtrochanteric fractures. We have also shown that many hip-fracture patients suffer AEs and the majority of these are preventable. We found no correlation between the presence of depression pre-fracture and poorer functional outcome one year after hip fracture.
|
|
| 5. |
- Kelly-Pettersson, Paula, et al.
(författare)
-
The influence of depression on patient-reported outcomes for hip-fracture patients 1 year after surgery : a prospective cohort study.
- 2020
-
Ingår i: Aging Clinical and Experimental Research. - : Springer Science and Business Media LLC. - 1594-0667 .- 1720-8319. ; 32:2, s. 247-255
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Depression is common in elderly hip-fracture patients and together with cognitive impairment is associated with increased risk of mortality.AIM: We aimed to examine the influence depression has on patient-reported outcome up to 1 year after acute hip fracture.METHODS: 162 hip-fracture patients participated in the prospective observational cohort study and were followed up at baseline, and 3 and 12 months using patient-reported outcome scores. Patients with cognitive impairment were excluded. Depression was defined as a score ≥ 8 on the depression subscale of the Hospital Anxiety Depression Scale (HADS D), having a diagnosis of depression or being treated with anti-depressant medication. Hip function was assessed using Harris Hip Score (HHS), EQ-5D was used to assess health status and Quality of life, and the Pain Numerical Rating Scale (PRNS) was used to assess pain levels. A linear regression model adjusted for group, age, sex, and ASA class was used to identify risk factors for functional outcome 12 months after fracture.RESULTS: 35 patients were included in the depression group versus 127 in the control group. No statistical differences were found in the demographic data (age, sex, ASA class, fracture type, operation method, living situation, activities of daily living ADL and clinical pathway) between the groups. In the regression model, we found no correlation between depression and the patient-reported outcome.CONCLUSION: In young elderly hip fracture patients without cognitive dysfunction, depression may not be of major importance for the rehabilitation of hip function in the short term.
|
|
| 6. |
- Kelly-Pettersson, Paula, et al.
(författare)
-
Waiting time to surgery is correlated with an increased risk of serious adverse events during hospital stay in patients with hip-fracture : A cohort study.
- 2017
-
Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 69, s. 91-97
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Hip fractures are common in the elderly and are associated with a high adverse event and mortality rate. Time to surgery is one of the major modifiable risk factors influencing adverse outcomes in hip-fracture patients. National guidelines and recommendations have been introduced which advocate specific time frames in which surgery should be performed i.e. within 24-48h. These time constraints have been arbitrarily set without being modelled on the linear assumption i.e. that risk increases continually over time and not within specific cut-off times.OBJECTIVES: To investigate how waiting time to surgery influenced the risk of serious adverse events in hip-fracture patients during the hospital stay and to examine how the risk increased over time.DESIGN: An observational single cohort study Participants 576 patients (72.4% females, mean [SD] age 82 [10]) years, with a hip fracture were included in the cohort study.METHODS: The outcomes of the study were the occurrence of serious adverse events during hospital stay, length of stay and one-year mortality. A structured medical record review was carried out to identify outcomes and mortality data was obtained from the Swedish National Death Registry. Waiting time to surgery was used as the exposure variable and age, sex, type of fracture, comorbidities using the American Society of Anaesthesiologists classification score and the presence of cognitive dysfunction were identified as confounders. A logistic regression analysis was performed to identify risk factors influencing outcomes.RESULTS: A total of 119 patients (20.6%) suffered 397 (range 1-5) serious adverse events during hospital stay. Every 10h of waiting time to surgery increased the risk of serious adverse events by 12% (odds ratio 1.12 [95% confidence interval 1.02-1.23]). We found no optimal cut-off times for waiting time to surgery. For every 24h of waiting time, the length of stay from surgery was increased by 0.6days (95% CI 0.1-1.1). We found no correlation between waiting time to surgery and one-year mortality.CONCLUSIONS: A large proportion of patients suffered from at least one serious adverse event after hip-fracture surgery and there are no safe limits for waiting time to surgery for hip-fracture patients. As the risk increases with every hour of waiting time, patients with higher American Society of Anesthesiologists classification scores, males and those with subtrochanteric fractures should be prioritized for surgery.
|
|
| 7. |
- Mukka, Sebastian, et al.
(författare)
-
External Validity of the HOPE-Trial Hemiarthroplasty Compared with Total Hip Arthroplasty for Displaced Femoral Neck Fractures in Octogenarians
- 2019
-
Ingår i: JBJS Open Access. - : JBJS. - 2472-7245. ; 4:2, s. 1-7
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Randomized controlled trials (RCTs) are the most reliable way of evaluating the effect of new treatments by comparing them with previously accepted treatment regimens. The results obtained from an RCT are extrapolated from the study environment to the general health care system. The ability to do so is called external validity. We sought to evaluate the external validity of an RCT comparing the results of total hip arthroplasty with those of hemiarthroplasty for the treatment of displaced femoral neck fractures in patients ≥80 years of age.Methods: This prospective, single-center cohort study included 183 patients ≥80 years of age who had a displaced femoral neck fracture. All patients were screened according to the inclusion and exclusion criteria for an RCT comparing total hip arthroplasty and hemiarthroplasty. The population for this study consisted of patients who gave their informed consent and were randomized into the RCT (consenting group, 120 patients) as well as those who declined to give their consent to participate (non-consenting group, 63 patients). The outcome measurements were mortality, complications, and patient-reported outcome measures. Follow-up was carried out postoperatively with use of a mailed survey that included patient-reported outcome questionnaires.Results: We found a statistically significant and clinically relevant difference between the groups, with the non-consenting group having a higher risk of death compared with the consenting group. (hazard ratio, 4.6; 95% confidence interval, 1.9 to 11.1). No differences were found between the groups in terms of patient-reported outcome measures or surgical complications.Conclusions: This cohort study indicates a higher mortality rate but comparable hip function and quality of life among eligible non-consenters as compared with eligible consenters when evaluating the external validity of an RCT in patients ≥80 years of age with femoral neck fracture.Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
|
|
| 8. |
- Persson, Marie, et al.
(författare)
-
Operational strategies to manage non-elective orthopaedic surgical flows : A simulation modelling study
- 2017
-
Ingår i: BMJ Open. - London : BMJ Publishing Group. - 2044-6055. ; 7:4
-
Tidskriftsartikel (refereegranskat)abstract
- Objectives To explore the value of simulation modelling in evaluating the effects of strategies to plan and schedule operating room (OR) resources aimed at reducing time to surgery for non-elective orthopaedic inpatients at a Swedish hospital. Methods We applied discrete-event simulation modelling. The model was populated with real world data from a university hospital with a strong focus on reducing waiting time to surgery for patients with hip fracture. The system modelled concerned two patient groups that share the same OR resources: hip-fracture and other non-elective orthopaedic patients in need of surgical treatment. We simulated three scenarios based on the literature and interaction with staff and managers: (1) baseline; (2) reduced turnover time between surgeries by 20â €..min and (3) one extra OR during the day, Monday to Friday. The outcome variables were waiting time to surgery and the percentage of patients who waited longer than 24â €..hours for surgery. Results The mean waiting time in hours was significantly reduced from 16.2â €..hours in scenario 1 (baseline) to 13.3â €..hours in scenario 2 and 13.6â €..hours in scenario 3 for hip-fracture surgery and from 26.0â €..hours in baseline to 18.9â €..hours in scenario 2 and 18.5â €..hours in scenario 3 for other non-elective patients. The percentage of patients who were treated within 24â €..hours significantly increased from 86.4% (baseline) to 96.1% (scenario 2) and 95.1% (scenario 3) for hip-fracture patients and from 60.2% (baseline) to 79.8% (scenario 2) and 79.8% (scenario 3) for patients with other non-elective patients. Conclusions Healthcare managers who strive to improve the timelines of non-elective orthopaedic surgeries may benefit from using simulation modelling to analyse different strategies to support their decisions. In this specific case, the simulation results showed that the reduction of surgery turnover times could yield the same results as an extra OR. © 2017 Published by the BMJ Publishing Group Limited.
|
|
| 9. |
- Pettersson, Paula Kelly, et al.
(författare)
-
The identification of adverse events in hip fracture patients using the Global Trigger Tool : A prospective observational cohort study.
- 2020
-
Ingår i: International Journal of Orthopaedic and Trauma Nursing. - : Elsevier BV. - 1878-1241 .- 1878-1292.
-
Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Hip fracture is common in the elderly and is associated with high comorbidity, mortality and complication rates. There has been an increase in the investigation of healthcare-related adverse events (AEs) in some patient groups but there is limited knowledge about hip fracture patients. The aim was to explore the incidence, preventability and nature of AEs in hip fracture patients.METHODS: One hundred and sixty three hip fracture patients participated. A record review was conducted of prospectively collected data using Global Trigger Tool methodology to identify AEs up to 90 days after surgery.RESULTS: Sixty two (38.0%) of 163 patients had at least one AE (range 1-7). One hundred and two AEs were identified and 62 (60.8%) were deemed preventable. Healthcare-associated infections e.g. pneumonia, urinary tract infections and pressure ulcers were common. AEs were more common in older patients and those with pre-existing health conditions. Fifty eight (56.9%) AEs caused temporary harm and 4 (3.9%) contributed to patient death.CONCLUSION: AEs are common in hip fracture patients and most are preventable. If the focus is on improving healthcare for these patients, we should be concentrating our efforts on reducing the number of these preventable AEs, with a particular emphasis on improving the care of older patients with pre-existing health conditions.
|
|
