| 1. |
- Axelsson, C, et al.
(författare)
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Dispatch codes of out-of-hospital cardiac arrest should be diagnosis related rather than symptom related.
- 2010
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Ingår i: European journal of emergency medicine : official journal of the European Society for Emergency Medicine. - : Lippincott Williams & Wilkins, Ltd.. - 1473-5695 .- 0969-9546. ; 17:5, s. 265-9
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Tidskriftsartikel (refereegranskat)abstract
- To describe the characteristics and outcome in out-of-hospital cardiac arrest (OHCA) in relation to (i) whether OHCA was coded by the dispatcher as a diagnosis or as a symptom and (ii) the delay until the first unit was alerted at the dispatch centre.
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| 2. |
- Berg, Lena M, et al.
(författare)
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An observational study of activities and multitasking performed by clinicians in two Swedish emergency departments
- 2012
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Ingår i: European journal of emergency medicine. - London : Chapman & Hall. - 0969-9546 .- 1473-5695. ; 19:4, s. 246-251
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: To explore the type and frequency of activities and multitasking performed by emergency department clinicians.Methods: Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis.Results: Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses’ and doctors’ offices were the most common locations for multitasking in the emergency department.Conclusion: This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.
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| 3. |
- Cone, David C, et al.
(författare)
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Comparison of the SALT and Smart triage systems using a virtual reality simulator with paramedic students
- 2011
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Ingår i: European journal of emergency medicine. - : Lippincott Williams & Wilkins. - 0969-9546 .- 1473-5695. ; 18:6, s. 314-321
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: Virtual reality systems may allow for organized study of mass casualty triage systems by allowing investigators to replicate the same mass casualty incident, with the same victims, for a large number of rescuers. The study objectives were to develop such a virtual reality system, and use it to assess the ability of trained paramedic students to triage simulated victims using two triage systems.METHODS: Investigators created 25 patient scenarios for a highway bus crash in a virtual reality simulation system. Paramedic students were trained to proficiency on the new 'Sort, Assess, Life saving interventions, Treat and Transport (SALT)' triage system, and 22 students ran the simulation, applying the SALT algorithm to each victim. After a 3-month washout period, the students were retrained on the 'Smart' triage system, and each student ran the same crash simulation using the Smart system. Data inputs were recorded by the simulation software and analyzed with the paired t-tests.RESULTS: The students had a mean triage accuracy of 70.0% with SALT versus 93.0% with Smart (P=0.0001). Mean overtriage was 6.8% with SALT versus 1.8% with Smart (P=0.0015), and mean undertriage was 23.2% with SALT versus 5.1% with Smart (P=0.0001). The average time for a student to triage the scene was 21 min 3 s for SALT versus 11 min 59 s for Smart (P=0.0001).CONCLUSION: The virtual reality platform seems to be a viable research tool for examining mass casualty triage. A small sample of trained paramedic students using the virtual reality system was able to triage simulated patients faster and with greater accuracy with 'Smart' triage than with 'SALT' triage.
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| 4. |
- Göransson, Katarina, 1974-, et al.
(författare)
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Interrater agreement : a comparison between two emergency department triage scales
- 2011
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Ingår i: European journal of emergency medicine. - : Lippincott Williams & Wilkins, Inc. - 0969-9546 .- 1473-5695. ; 18:2, s. 68-72
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVEThe aim was to elucidate if, by strictly applying the Adaptive Process Triage (ADAPT) scale, the interrater agreement increased among the participating registered nurses (RNs) than when triaging according to the older scale, which allowed subjective interpretations of signs and symptoms. METHODSNineteen patient scenarios were triaged in 2006 by 45 RNs using the previous triage scale, and in 2008 by 30 RNs using ADAPT. RESULTSThere was no significant difference (P=0.65) between the two triage scales with regard to level of overall exact agreement (κ value 0.529 vs. 0.472). The same triage level was more often chosen when using the ADAPT system as compared to the earlier triage scale and dispersion across the triage levels was also reduced when using ADAPT. Eight (42%) of the patient scenarios were triaged as both unstable and stable by ADAPT, and 11 (58%) when the older scale was applied. Fourteen (74%) of the scenarios could not be allocated to a defined triage level by ADAPT. Five main reasons for such triage decisions were identified. CONCLUSIONBoth the triage scales showed moderate overall agreements, while dispersion of triage decisions across several triage levels declined when ADAPT was used. Although the algorithm for acuity allocation by ADAPT seemed well defined, many patient scenarios were triaged as both unstable and stable and thus allocated to various triage levels. If ADAPT is to function as a safe triage tool with low interrater variability, further revision of the triage algorithms is needed.
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| 5. |
- Göransson, Katarina, 1974-, et al.
(författare)
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Patients’ pathway to emergency care : is the emergency department their first choice of care?
- 2013
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Ingår i: European journal of emergency medicine. - : Lippincott Williams & Wilkins, Inc. - 0969-9546 .- 1473-5695. ; 20:1, s. 45-50
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVESTo investigate whether patients came directly to the emergency department (ED) or whether they had taken any other actions or activities within the healthcare system before attending the ED. An additional aim was to increase our understanding of the potential determinants between patients’ ED-seeking behaviour and patient-related data. METHODSThis prospective descriptive study was carried out at the ED at a level one trauma centre at a university hospital in Sweden. During 12 weeks in 2008, a 20-item study-specific questionnaire was distributed by research assistants to patients arriving either by their own means or by ambulance to the ED. In addition, patient-specific data were gathered from the electronic patient records. RESULTSA total of 2014 patients participated in the study, of whom 1192 (59%) reported to have carried out healthcare-related actions or activities before their visit to the ED. A general practitioner was the most common (29.1%) healthcare provider to have been in contact with. Female patients and patients with a longer duration of symptoms sought other health caregivers before the ED visit to a significantly higher extent (P<0.001, 0.003). Other caregivers’ referral rate to the ED was 60.1–87.9%. Accessibility to other caregivers was generally rated as easy. CONCLUSIONA large proportion of ED patients sought previous healthcare before seeking care at the ED. Female patients and patients with longer symptom duration more often sought other caregivers before seeking ED care.
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| 6. |
- Kjaergaard, Benedict, et al.
(författare)
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Low plasma potassium in deep hypothermic cardiac arrest indicates that cardiac arrest is secondary to hypothermia : a porcine study
- 2010
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Ingår i: European journal of emergency medicine. - 0969-9546 .- 1473-5695. ; 17:3, s. 131-135
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: In accidental hypothermia, normal signs of death are unreliable. It is generally accepted that a lifeless person is beyond the limits of rescue if plasma potassium (P-potassium) is higher than10 mmol/l. However, the rate of increase in potassium or in other markers after cardiac arrest has not been carefully studied in hypothermic individuals. The aim of this animal study was to assess biochemical changes after anoxic circulatory arrest at hypothermia and at normothermia followed by external cooling. METHODS: Five pigs were treated with heparin and extracorporeal circulation and cooled to 20 degrees C (primary hypothermia group). The animals were weaned from extracorporeal circulation, suffered cardiac arrest, and were cooled externally with ice to mimic victims found in a cold environment. With the use of intermittent external cardiac compressions mixing the blood, arterial P-potassium was followed after cardiac arrest until the level exceeded 10 mmol/l. Another group of five pigs (anoxic cardiac arrest group) were treated with heparin and killed by anoxia at normothermia and were thereafter treated and followed similarly to the primary hypothermia group. RESULTS: In primary hypothermia P-potassium exceeded 10 mmol/l after median 3.5 h, whereas in anoxic cardiac arrest P-potassium exceeded 10 mmol/l after median 1 h. CONCLUSION: This study shows that if cardiac arrest occurs before hypothermia is established, P-potassium increases quickly in contrast to the situation when hypothermia induces cardiac arrest. Thus, a low P-potassium in a hypothermic individual with cardiac arrest indicates that cardiac arrest occurred recently or was secondary to the hypothermic event.
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| 7. |
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| 8. |
- Källberg, Ann-Sofie, et al.
(författare)
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Medical errors and complaints in emergency department care in Sweden as reported by care providers, health care staff and patients : a national review
- 2013
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Ingår i: European journal of emergency medicine. - London : Chapman & Hall. - 0969-9546 .- 1473-5695. ; 20:1, s. 33-38
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Despite an increase in research, there is still a lack of knowledge about patient safety in emergency departments (EDs) in many European countries. The aim of this study was therefore to describe the incidence and types of reported medical errors and complaints in ED care in Sweden.Methods: Data reported in 2009 were gathered from national authorities, including the National Board of Health and Welfare, the Medical Responsibility Board, the Patients Advisory Committees, and local incident-reporting systems. Data were analyzed by content analysis.Results: Among 428 cases reported by care providers to the National Board of Health and Welfare, 64 (15.0%) were related to ED care. As several cases contained more than one medical error, 92 errors were identified, out of which 39 (42.4%) were related to diagnostic procedures. Among the 4628 cases of complaints reported by patients to the Medical Responsibility Board, 306 (6.6%) were related to ED care. In total, 437 complaints regarding perceived medical errors were identified (several cases contained more than one error), with 189 (43.2%) pertaining to diagnostic procedures. A total of 1341 complaints about ED care were made by patients to the Patients Advisory Committees (n=21), of which 655 (48.8%) were related to care and treatment. There were 7434 medical errors reported to local incident-reporting systems at the EDs (n=45). Of these, 1450 (19.5%) referred to care and treatment.Conclusion: Medical errors and complaints at Swedish EDs, as reported by both patients and care providers, were related mainly to diagnostic procedures and treatments.
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| 9. |
- Lindström, Veronica, et al.
(författare)
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Feasibility of a computer-assisted feedback system between dispatch centre and ambulances
- 2011
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Ingår i: European journal of emergency medicine. - 0969-9546 .- 1473-5695. ; 18:3, s. 143-147
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the study was to evaluate the feasibility of a newly developed computer-assisted feedback system between dispatch centre and ambulances in Stockholm, Sweden. Methods: A computer-assisted feedback system based on a Finnish model was designed to fit the Swedish emergency medical system. Feedback codes were identified and divided into three categories; assessment of patients' primary condition when ambulance arrives at scene, no transport by the ambulance and level of priority. Two ambulances and one emergency medical communication centre (EMCC) in Stockholm participated in the study. A sample of 530 feedback codes sent through the computer-assisted feedback system was reviewed. The information on the ambulance medical records was compared with the feedback codes used and 240 assignments were further analyzed. Results: The used feedback codes sent from ambulance to EMCC were correct in 92% of the assignments. The most commonly used feedback code sent to the emergency medical dispatchers was 'agree with the dispatchers' assessment'. In addition, in 160 assignments there was a mismatch between emergency medical dispatchers and ambulance nurse assessments. Conclusion: Our results have shown a high agreement between medical dispatchers and ambulance nurse assessment. The feasibility of the feedback codes seems to be acceptable based on the small margin of error. The computer-assisted feedback system may, when used on a daily basis, make it possible for the medical dispatchers to receive feedback in a structural way. The EMCC organization can directly evaluate any changes in the assessment protocol by structured feedback sent from the ambulance.
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| 10. |
- Schilling, Ulf Martin
(författare)
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Cutting costs : the impact of price lists on the cost development at the emergency department.
- 2010
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Ingår i: European journal of emergency medicine. - 0969-9546 .- 1473-5695. ; 17:6, s. 337-339
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Tidskriftsartikel (refereegranskat)abstract
- It was shown that physicians working at the Swedish emergency department (ED) are unaware of the costs for investigations performed. This study evaluated the possible impact of price lists on the overall laboratory and radiology costs at the ED of a Swedish university hospital. Price lists including the most common laboratory analyses and radiological investigations at the ED were created. The lists were distributed to all internal medicine physicians by e-mail and exposed above their working stations continually. No lists were provided for the orthopaedic control group. The average costs for laboratory and radiological investigations during the months of June and July 2007 and 2008 were calculated. Neither clinical nor admission procedures were changed. The physicians were blinded towards the study. Statistical analysis was performed using the Student's t-test. A total of 1442 orthopaedic and 1585 medical patients were attended to in 2007. In 2008, 1467 orthopaedic and 1637 medical patients required emergency service. The average costs per patient were 980.27 SKR (98€)/999.41 SKR (100€, +1.95%) for orthopaedic and 1081.36 SKR (108€)/877.3 SKR (88€, -18.8%) for medical patients. Laboratory costs decreased by 9% in orthopaedic and 21.4% in medical patients. Radiology costs changed +5.4% in orthopaedic and -20.59% in medical patients. The distribution and promotion of price lists as a tool at the ED to heighten cost awareness resulted in a major decrease in the investigation costs. A significant decrease in radiological costs could be observed. It can be concluded that price lists are an effective tool to cut costs in public healthcare.
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