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| 2. |
- Letterstål, Anna
(författare)
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SVAR – Ett unikt svenskt akutvårdsregister
- 2010
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 107:43, s. 2659-2660
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Det nya kvalitetsregistret för akutsjukvård, SVAR, har potential att bli en unik informationskälla för svensk akutsjukvård.
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| 3. |
- Muntlin, Åsa, 1971-, et al.
(författare)
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Outcomes of a nurse-initiated intravenous analgesic protocol for abdominal pain in an emergency department : a quasi-experimental study
- 2011
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 48:1, s. 13-23
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Tidskriftsartikel (refereegranskat)abstract
- Background: Abdominal pain is one of the most frequent reasons for seeking care in an emergency department. Surveys have shown that patients are not satisfied with the pain management they receive. Reasons for giving inadequate pain management may include poor knowledge about pain assessment, myths concerning pain, lack of communication between the patient and healthcare professional, and organizational limitations. Objectives: The aim of the study was to investigate the outcome of nursing assessment, pain assessment and nurse-initiated intravenous opioid analgesic compared to standard procedure for patients seeking emergency care for abdominal pain. Outcome measures were: a) pain intensity, b) frequency of received analgesic, c) time to analgesic, d) transit time, and e) patients’ perceptions of the quality of care in pain management. Design: A quasi-experimental design with ABA phases was used. Setting: The study was conducted in an emergency department at a Swedish university hospital. Participants: Patients with abdominal pain seeking care in the emergency department were invited to participate. A total of 50, 100 and 50 patients, respectively, were included for the three phases of the study. The inclusion criteria were: ongoing abdominal pain not lasting for more than 2 days, ≥18 years of age and oriented to person, place and time. Exclusion criteria were: abdominal pain due to trauma, in need of immediate care and pain intensity scored as 9-10. Methods: The patients’ perceptions of the quality of care in pain management in the emergency department were evaluated by means of a patient questionnaire carried out in the three study phases. The intervention phase included education, nursing assessment protocol and a range order for analgesic. Results: The nursing assessment and the nurse-initiated intravenous opioid analgesic resulted in significant improvement in frequency of receiving analgesic and a reduction in time to analgesic. Patients perceived lower pain intensity and improved quality of care in pain management. Conclusions: The intervention improved the pain management in the emergency department. A structured nursing assessment could also affect the patients’ perceptions of the quality of care in pain management in the emergency department.
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| 5. |
- Säfwenberg, Urban, et al.
(författare)
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Differences in Long-term Mortality for Different Emergency Department Presenting Complaints
- 2008
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Ingår i: Academic Emergency Medicine. - : Wiley. - 1069-6563 .- 1553-2712. ; 15:1, s. 9-16
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To characterize long-term mortality based on previous emergency department (ED) presenting complaints. METHODS: The authors followed, for 10 years, all of the 12,667 nonsurgical patients visiting an ED during 1995/1996. Differences in standardized mortality ratio (SMR) depending on presenting complaints were then investigated. RESULTS: During follow-up, 5,324 deaths occurred (mortality rate 6.6 per 100 person-years at risk), giving a SMR of 1.33 (95% CI = 1.30 to 1.37, p < 0.001) when compared with the expected mortality in the catchment area. Different presenting complaints were associated with different long-term mortality rates, independent of age and gender (p < 0.0001). The subjects with seizures had the highest SMR (2.62, 95% CI = 2.13 to 3.22) followed by intoxications (2.51, 95% CI = 2.11 to 2.98), asthmalike symptoms (1.84, 95% CI = 1.65 to 2.06), and hyperglycemia (1.67, 95% CI = 1.42 to 1.95). The largest complaint group, chest pain, had a 20% higher mortality rate than the background population (95% CI = 1.13 to 1.26). Patients with a discharge diagnosis of myocardial infarction, but without chest pain as the presenting complaint, had an increased long-term mortality (hazard ratio [HR] 1.70, 95% CI = 1.15 to 2.42) compared to the group with chest pain. In contrast, stroke patients without strokelike symptoms had a reduced mortality (HR 0.74, 95% CI = 0.65 to 0.84) compared to patients with strokelike symptoms. CONCLUSIONS: Long-term age- and gender-adjusted mortality is the highest with seizures out of 33 presenting complaints and differs markedly between different ED admission complaints. Furthermore, depending on the admission complaint, long-term mortality differs within the same discharge diagnosis. Hence, the presenting complaint adds unique information to the discharge diagnosis regarding long-term mortality in nonsurgical patients.
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| 6. |
- Säfwenberg, Urban, et al.
(författare)
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Increased long-term mortality in patients with repeated visits to the emergency department
- 2010
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Ingår i: European journal of emergency medicine. - 0969-9546 .- 1473-5695. ; 17:5, s. 274-279
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Tidskriftsartikel (refereegranskat)abstract
- Background Revisits to the emergency department (ED) are common. It is not clear whether the number of revisits, the time between revisits or the reason for the revisits are associated with increased mortality. Methods During 1 year, the number of visits, the reason for the visit and the time between visits were recorded in 15 607 nonsurgical ED patients and related to 1-year and 5-year mortality. Results Five-year mortality was dependent on the number of revisits in an inverse U-shaped manner. When compared with one-time visitors, patients with three visits showed an increased 5-year mortality (hazard ratio 1.85, 95% confidence interval 1.58-2.16, P < 0.0001), whereas in patients with four or five visits mortality decreased. Patients with six or more visits had a 5-year mortality not different from one-time visitors. The impact of the number of visits was, however, dependent on the presenting complaint (P < 0.0001). Furthermore, the time between two adjacent visits influenced long-term mortality in an inverse U-shaped manner. In patients not admitted to the ward, a revisit after 2-3 days was associated with increased mortality (hazard ratio 1.89, 95% confidence interval 1.06-3.35, P = 0.03). In patients revisiting the ED with the same adjacent presenting complaint, mortality differed depending on the complaint (P < 0.0001). Conclusion In nonsurgical patients revisiting the ED, long-term mortality was dependent on both the number of revisits, as well as the time between two visits in an inverse U-shaped manner. This indicates a possibility of detecting the transition level between appropriate medical utilization and inappropriate frequent ED use.
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| 7. |
- Säfwenberg, Urban, 1960-
(författare)
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Presenting complaint and mortality in non-surgical emergency medicine patients
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- In 1995 and 2000 a total of 29 886 non surgical ED visits at Uppsala University Hospital were registered. Presenting complaint, admittance to a ward, length of stay, in-hospital mortality, discharge diagnoses, 30-day and long-term mortality were registered. The presenting complaints were sorted into 33 presenting complaint groups (PCGs). For different PCGs there was different in-hospital fatality rate. Compared to the largest PCG, chest pain, the gender and age adjusted OR was 2.12 (95% CI 1.01 – 4.44) for the miscellaneous complaint group and 2.04 (95 % CI 1.35 – 3.08) for the stroke–like symptom group. Within a given PCG the in-hospital mortality could vary depending on discharge diagnoses. By relating PCG and long term mortality to the expected mortality in the population, the Standardized Mortality Ratio (SMR) could be calculated. The SMR was found to be highest in seizure 2.62 (95 % CI 2.13 – 3.22), intoxication 2.51 (95% CI 2.11-2.98) and symptoms of asthma 1.8 (1.65 – 2.06). For the same discharge diagnoses the long term mortality could differ considerably depending on PCG at ED arrival (p<0.001). Between 1995 and 2000 there was a 30 % increase in ED visits at the non surgical ED. PCGs representing lesser severe conditions had increased. Demographic changes could account for 45 % of the increment and the remaining increase could be ascribed to change in visiting pattern. In the 2000 cohort 41.0 % of all visits were performed by re-visitors. The number of revisits and five-year mortality had an inversed u-shaped relationship were patients with three re-visits within the same year had an increased mortality compared to patients with more or less visits. Conclusion: It is possible to define presenting complaint groups (PCGs) that are robust and consistent over time and useful as a tool for epidemiological studies in the ED.
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| 8. |
- Säfwenberg, Urban, et al.
(författare)
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The Emergency Department presenting complaint as predictor of in-hospital fatality
- 2007
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Ingår i: European journal of emergency medicine. - 0969-9546 .- 1473-5695. ; 14:6, s. 324-331
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Tidskriftsartikel (refereegranskat)abstract
- Background: The relationship between major discharge diagnoses and prediction of in-hospital death has been intensively studied. The relation between the presenting complaint at the Emergency Department (ED) and in-hospital fatality, however, is less well known. Objective: To investigate if presenting complaints add information regarding in-hospital fatality risk for nonsurgical ED patients. Methods: Investigating the relationship of in-hospital fatality rate and presenting complaint by comparing the presenting complaints, discharge diagnoses and in-hospital fatality for all nonsurgical patients visiting the ED during 1 year. Results: Of 12 995 nonsurgical admissions, 40% were treated as in-hospital patients. Among these, 328 in-hospital deaths occurred. Age was the most powerful predictor of death in hospitalized patients (P<0.0001). After adjustment for age, the female sex was found to be protective [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.92, P=0.007)]. Compared with the largest complaint group, chest pain with an in-hospital fatality rate of 2.5%, there was a significantly increased risk of dying among those with stroke-like symptoms (OR 2.04, 95% CI 1.35-3.08, P=0.0007), dyspnoea (OR 1.95, 95% CI 1.27-3.00, P=0.002) or general disability (OR 1.81, 95% CI 1.17-2.79, P=0.008). Conclusions: The presenting complaint at the ED carries valuable information of the risk for in-hospital fatality in nonsurgical patients. This knowledge can be valuable in the prioritization between different patient groups in the process of initiating diagnostics and treatment procedures at the ED.
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