| 1. |
|
|
| 2. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
-
Reasons for longer LOS at the emergency departments: Practical, patient‐centred, medical, or cultural?
- 2020
-
Ingår i: International Journal of Health Planning and Management. - : Wiley. - 0749-6753 .- 1099-1751. ; 34:4
-
Tidskriftsartikel (refereegranskat)abstract
- Emergency department (ED) overcrowding is caused by external and/or internal factors. One critical internal factor, leading to longer length of stay (LOS) at ED (eg, frequent ED users), is the physician's uncertainty in management of patients with unclear diagnosis and or complex medical history. The aim of this study was to identify whether the causes of physicians' uncertainty was practical, patient‐centred, medical, or cultural. Using earlier published dimensions of uncertainty, 18 physicians were asked to reply to a template by choosing a relevant dimension that causes a delay in assessment of a known complex patient. This stage was completed by interviews through which participants had an opportunity to express their concerns and critical thoughts, if any. The data obtained from the template were collected and analysed. The interviews were recorded and transcribed verbatim. The results of the template indicated medical dimension as the main factor in delayed assessment of a complex patient. However, this finding was challenged by the results of the interviews, which indicated higher impact of personal/routines/cultural dimension (eg, being afraid of criticism, reprimand, and gossip or feelings of guilt). Although medical, patient‐centred, and practical issues are important causes of longer LOS at ED, physicians' working and professional environment may have a higher impact than previously perceived. The uncertainty caused by interpersonal, organisational, and cultural issues within a clinic/hospital seems to influence the physician's ability to make decisions and thus a patient's medical outcome.
|
|
| 3. |
- Wennman, Ingela, et al.
(författare)
-
Actions taken affecting lead time in the care pathway for low-priority patients with a suspected stroke: A critical incident study
- 2022
-
Ingår i: International Emergency Nursing. - : Elsevier BV. - 1755-599X .- 1878-013X. ; 60
-
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.
|
|
| 4. |
- Wennman, Ingela, et al.
(författare)
-
Experienced critical incidents affecting lead-times in the stroke care chain for low-priority patients - A qualitative study with critical incident technique
- 2021
-
Ingår i: International Emergency Nursing. - : Elsevier. - 1755-599X .- 1878-013X. ; 58
-
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.
|
|
| 5. |
- Wennman, Ingela, et al.
(författare)
-
Fast track to stroke unit for patients not eligible for acute intervention, a case-control register study on 1066 patients.
- 2023
-
Ingår i: Scientific reports. - : Springer Nature. - 2045-2322. ; 13:1
-
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.
|
|
| 6. |
- Wennman, Ingela, et al.
(författare)
-
Organizational Changes Needed in Disasters and Public Health Emergencies: A Qualitative Study among Managers at a Major Hospital
- 2022
-
Ingår i: International Journal of Disaster Risk Science. - : Springer Science and Business Media LLC. - 2095-0055 .- 2192-6395. ; 13, s. 481-494
-
Tidskriftsartikel (refereegranskat)abstract
- Most hospitals have a contingency plan, based on all-risks and all-hazards assessment principles. However, emerging threats and risks often necessitate a flexible approach to emergency management at several levels of a disaster response system, for example, in hospitals. Sweden, and possibly other countries, has limited possibilities of surge capacity in the management of large-scale disasters and emergencies, which necessitates a local/national partnership and a flexible local disaster and contingency plan. This study evaluates the opinions of a selected managerial group, both at operative and strategic levels, regarding possible changes in a major hospital’s contingency plan during the ongoing COVID-19 pandemic. Semistructured interviews were conducted to explore the elements of surge capacity and an operational tool, consisting of command and control, safety, communication, assessment, triage, treatment, and transport. The results show a need to create feasible management methods that can be evaluated, establish clear leadership, put preparedness as a constant point on the highest managerial agenda, improve external monitoring, and create a regional coordinating center. Furthermore, the results emphasize the significant role played by the incident command system and qualified leadership to facilitate competent and crucial medical decision making, as well as to provide reliable communication, collaboration, and coordination in a multi-agency response system during dynamic and unexpected emergencies. These steps enable a constant connection between reactive contingency plans and the proactivity in continuous risk assessment and enhance the flexibility of the contingency plans.
|
|
| 7. |
- Wennman, Ingela
(författare)
-
Outcomes and Experiences of a Fast Track - A direct admission process from ambulance to stroke unit for patients not eligible for acute intervention
- 2023
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background Stroke is a serious medical condition, and the time before acute intervention and care at stroke units is crucial. People who suffer from a stroke and are not eligible for stroke alert are often transported to the emergency department (ED), where they risk experiencing a long length of stay (LOS) before being admitted to the stroke unit. Long LOS in ED is associated with health-associated harms (both bodily and psychological harm), which can be avoided if sufficient measures are taken in the care pathway. For selected patients, a direct admission process (Fast Track) from emergency medical services (EMS) to the stroke unit has been tried to shorten the care pathway LOS, reduce health-associated harms and use resources more efficiently. Overall aim The goal of this thesis was to describe and explore a changed organisational care pathway process from EMS to the stroke unit for patients not eligible for stroke alert, focusing on both patient and organisational perspectives in terms of safety outcomes and factors affecting LOS in the care pathway. Methods Data were gathered through a case-control design, including both prospective and retrospective data (Study I) and individual explorative descriptive interviews with nurses from the entire care pathway (Studies II and III), and through a case-control design using quality registers (Study IV). Quantitative data were analysed using descriptive and inferential statistics (Studies I and IV), whereas qualitative data were analysed using the critical incident technique (Studies II and III). Main findings The changed care pathway (i.e. direct transport from nurse-manned EMS to the stroke unit) was indicated to be safe for selected patients and was associated with relatively high diagnostic accuracy. The care pathway LOS was significantly shortened, but there were no significant differences regarding complications or patient-reported outcome measurement (PROM) between the Fast Track patients and patients transported via the ED. The findings showed that the most prevalent critical factors that negatively affected the Fast Track care pathway were connected to the participants’ experiences of how different units other than their own worked, the challenges of assessing patients’ symptoms, workflows/organisational silos, available hospital beds and the atmosphere in this context. The most common enablers of a well-running Fast Track were linked to patients’ and relatives’ involvement/participation, to staff members’ level of experience/skills and to cross-sectional collaboration/professional relations. To manage delays, staff members took actions by safeguarding the patients, striving to gain an overview of the situation, convincing others to work in different ways and building trust with patients/relatives. The situation affected the staff in all departments by causing unpleasant feelings that they kept to themselves and did not communicate. Over time, the Fast Track showed a decreasing trend regarding the number of contacts from EMS to the stroke coordinator, a decreasing trend regarding the acceptance of the Fast Track and an increasing trend regarding the denial of the Fast Track, associated with the number of hospital beds. The organisational prerequisites for maintaining this direct admission process became more and more limited over the years, and there was a failing degree of obedience to pre-defined guidelines. This might have consequences for the care pathway LOS, health-associated harms and strains on the healthcare resources. Conclusions The Fast Track concept was indicated to be safe for selected patients. It was feasible and was expected to shorten the patients’ time in the care pathway compared to patients transported via the ED. However, there were no significant differences between Fast Track and ED patients regarding complications or PROM. The findings revealed several critical factors related to human and organisational causes that affect the Fast Track process both negatively and positively. In addition, the findings showed a decreasing trend in getting acceptance from the hospital for Fast Track when suggested and consequently fewer Fast Tracks.
|
|
| 8. |
- Wennman, Ingela, et al.
(författare)
-
The clinical consequences of a pre-hospital diagnosis of stroke by the emergency medical service system. A pilot study.
- 2012
-
Ingår i: Scandinavian journal of trauma, resuscitation and emergency medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 20
-
Tidskriftsartikel (refereegranskat)abstract
- There is still a considerable delay between the onset of symptoms and arrival at a stroke unit for most patients with acute stroke.The aim of the study was to describe the feasibility of a pre-hospital diagnosis of stroke by an emergency medical service (EMS) nurse in terms of diagnostic accuracy and delay from dialing 112 until arrival at a stroke unit.Between September 2008 and November 2009, a subset of patients with presumed acute stroke in the pre-hospital setting were admitted by EMS staff directly to a stroke unit, bypassing the emergency department. A control group, matched for a number of background variables, was created.In all, there were 53 patients in the direct admission group, and 49 patients in the control group. The median delay from calling for an ambulance until arrival at a stroke unit was 54 minutes in the direct admission group and 289 minutes in the control group (p < 0.0001).In a comparison between the direct admission group and the control group, a final diagnosis of stroke, transient ischemic attack (TIA) or the sequelae of prior stroke was found in 85% versus 90% (NS). Among stroke patients who lived at home prior to the event, the percentage of patients that were living at home after 3 months was 71% and 62% respectively (NS).In a pilot study, the concept of a pre-hospital diagnosis of stroke by an EMS nurse was associated with relatively high diagnostic accuracy in terms of stroke-related diagnoses and a short delay to arrival at a stroke unit. These data need to be confirmed in larger studies, with a concomitant evaluation of the clinical consequences and, if possible, the level of patient satisfaction as well.
|
|
| 9. |
- Wennman, Ingela, et al.
(författare)
-
Urgent care centre in Sweden-the integration of teams and perceived effects.
- 2019
-
Ingår i: The International journal of health planning and management. - : Wiley. - 1099-1751 .- 0749-6753.
-
Tidskriftsartikel (refereegranskat)abstract
- An urgent care centre (UCC) is an upcoming trend in Swedish health care. Although UCCs have been established in other countries, their effectiveness and value have not yet been studied in Sweden. The aim of this study was to investigate the interaction between the UCC and emergency department (ED) by using validated evaluation models. One adult ED (AED) and one child ED (CED), together with a newly established UCC nearby, were included in this study. The interaction between the UCC team and the ED teams was studied by using two evaluation models: one for evaluation of integration and the other one for the evaluation of the effects, in terms of perceived relief of the ED after the establishment of the UCC. It was evident that integration was achieved early on in the course of the follow-up. However, the perception of integration varied between low (EDs) and high collaboration (UCC). All respondents of the EDs indicated relief, in terms of pace and pressure on the ED since the UCC was established. This study indicates that the grade of integration and collaboration between UCC and ED can be achieved automatically and very early during the establishment. It also shows that UCCs can be a competent complement to EDs and alleviate some of the heavy pressure placed on EDs due to ED overcrowding.
|
|
| 10. |
- Wennman, Ingela, et al.
(författare)
-
"We Are Here for You All the Way"-Patients' and Relatives' Experiences of Receiving Advanced Home Care
- 2020
-
Ingår i: American Journal of Hospice & Palliative Medicine. - : SAGE Publications. - 1049-9091 .- 1938-2715. ; 37:9, s. 669-74
-
Tidskriftsartikel (refereegranskat)abstract
- Background: It is of great importance to understand how patients and their close relatives experience the pros and cons of advanced home care so as to further develop this quickly growing choice of care. Objective: The aim of this study was to explore the experiences of receiving advanced home care among patients affected by life-threatening illness and their close relatives. Design: The study was an interview study conducted with patients in their homes. Some patient interviews were conducted together with a close relative participating. Setting/Participants: Patients registered in advanced home care in 2017 were offered the opportunity to participate in the study. The selection criteria were that the patient was within grade 3 of the Eastern Cooperative Oncology Group's Performance Status, older than 18 years, able to orient to time and place, and not newly registered. Analysis: The interviews were recorded and transcribed verbatim and analyzed with qualitative content analysis. Results: A total of 11 interviews were conducted: 8 with patients and 1 or 2 close relatives together; and 3 with the patient alone. It resulted in 3 main categories: create a safe environment, see the person, and better to manage care at home. Conclusion: The results of this study show that patients and close relatives perceived that advanced home care was a safe and secure form of caring during advanced as well as end-of-life care.
|
|
