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Granlund L, Brännström I, Lindström V. Factors influencing non-conveyance care encounters in the ambulance service, registered nurses experiences - a qualitative study. BMC Nurs 2024; 23:271. [PMID: 38658953 PMCID: PMC11044363 DOI: 10.1186/s12912-024-01899-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND There is a notable variation in the percentage of non-conveyed patients within the ambulance service. Discharging patients at the scene includes a risk of adverse events, and both patients and ambulance clinicians experience the complexity of non-conveyance. Therefore, this study aimed to describe factors influencing the care encounter when care in the ambulance service concludes with non-conveyance. METHOD A qualitative study design employing the critical incident technique for data collection through individual interviews, and a qualitative analysis based on Fridlund et al. descriptions was utilized. The study conforms to the COREQ checklist for reporting qualitative research. RESULTS Fourteen Registered Nurses (RN) described 30 incidents and various factors were identified as influencing the care encounter. The factors included communication, sharing information, maintaining a secure and confident approach, organizational aspects, applying person-centered care in collaboration with the patient, relatives, and other caregivers, and an overall understanding of the patient's entire situation. These factors were integrated into the RNs' decision-making process for non-conveyance. CONCLUSION The decision-making process for non-conveyance by RNs is a multifaceted approach that incorporates several factors. Communication, sharing of information, maintaining a secure and confident approach, organizational aspects, applying person-centered care in collaboration with the patient, relatives, and other caregivers, and a comprehensive understanding of the patient's entire situation. These findings have the potential to contribute to the development of guidelines supporting the RNs working in the ambulance service in their decisions regarding non-conveyance. Further research is needed on the patient's and relatives' perspective on non-conveyance otherwise, patient participation and partnership in person-centered care are not possible to achieve.
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Affiliation(s)
- L Granlund
- Department of Ambulance Service, Region Västerbotten, Umeå, Sweden
| | - I Brännström
- Department of Ambulance Service, Region Västerbotten, Umeå, Sweden
| | - V Lindström
- Department of Nursing, Umeå University, Umeå, Sweden.
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Strandås M, Vizcaya-Moreno MF, Ingstad K, Sepp J, Linnik L, Vaismoradi M. An Integrative Systematic Review of Promoting Patient Safety Within Prehospital Emergency Medical Services by Paramedics: A Role Theory Perspective. J Multidiscip Healthc 2024; 17:1385-1400. [PMID: 38560485 PMCID: PMC10981423 DOI: 10.2147/jmdh.s460194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
Timely and effective prehospital care significantly impacts patient outcomes. Paramedics, as the frontline providers of emergency medical services, are entrusted with a range of critical responsibilities aimed at safeguarding the well-being of patients from the moment they initiate contact in the out-of-hospital environment to the time of handover at healthcare facilities. This study aimed to understand the multifaceted roles of paramedics in promoting patient safety within the context of prehospital emergency medical services. A systematic review with an integrative approach using the Whittemore and Knafl's framework was performed examining qualitative, quantitative, and mixed-methods research, then conducting data assessment, quality appraisal, and narrative research synthesis. Literature search encompassed PubMed (including MEDLINE), Scopus, Cinahl, ProQuest, Web of Science, and EMBASE, with the aim of retrieving studies published in English in the last decade from 2013 to 2023. To conceptualize the roles of paramedics in ensuring patient safety, the review findings were reflected to and analyzed through the role theory. The preliminary exploration of the database yielded 2397 studies, ultimately narrowing down to a final selection of 16 studies for in-depth data analysis and research synthesis. The review findings explored facilitators and obstacles faced by paramedics in maintaining patient safety in terms of role ambiguity, role conflict, role overload, role identity, and role insufficiency in the dynamic nature of prehospital care. It also highlighted the diverse roles of paramedics in ensuring patient safety, which encompassed effective communication and decision making for the appropriate management of life-threatening emergencies. The effectiveness of paramedics in playing their roles in promoting patient safety relies on acknowledging the contributions of paramedics to the culture of patient safety; training and educational initiatives focused on enhancing their decision-making abilities and both their non-technical and technical competencies; developing relevant guidelines and protocols; improving collaboration between paramedics and other healthcare peers; optimizing environmental conditions and equipment; fostering a supportive work environment.
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Affiliation(s)
- Maria Strandås
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | | | - Kari Ingstad
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
| | - Jaana Sepp
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Ljudmila Linnik
- Tallinn Health Care College, Academic and International Affairs Office, Tallin, Estonia
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
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3
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Fager C, Rantala A, Svensson A, Holmberg M, Bremer A. Nurses' use of an advisory decision support system in ambulance services: A qualitative study. J Adv Nurs 2024. [PMID: 38515226 DOI: 10.1111/jan.16165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/06/2024] [Accepted: 03/11/2024] [Indexed: 03/23/2024]
Abstract
AIM To illuminate from the perspective of nurses in ambulance services the experiences of using a web-based advisory decision support system to assess care needs and refer patients. DESIGN Inductive and descriptive approaches. METHOD Thirteen semi-structured interviews were conducted in the spring of 2020. The data were analysed through the reflexive thematic analysis. RESULTS The Swedish web-based advisory decision support system (ADSS) was found to strengthen nurses' feelings of security when they assess patients' care needs, promote their competence and professional pride, and help them manage stress. However, the system also generated difficulties for nurses to adjust to the dynamic ambulance team and revealed a discrepancy between their professional roles and responsibilities to refer patients and provide self-care advice. The nurses thought that the support system facilitated their increased participation and helped them understand patients and significant others by offering transparency in assessment and decision making. Thus, the support system provides nurses with an opportunity to strengthen patients' independence through information and education. However, in the care relationship, nurses worked to overcome patients' expectations. CONCLUSION Nurses using the ADSS increased their security while performing assessments and referrals and found new opportunities to provide information and promote understanding of their decisions. However, nursing care values can be threatened when new support systems are introduced, especially as ambulance services become increasingly protocol-driven. IMPLICATIONS FOR PROFESSION AND/OR PATIENT CARE These findings have implications for nurses' work environments and help them maintain consistency in making medical assessments and in providing equivalent self-care advice when referring patients to the different levels of care. The findings will also impact researchers and policymakers who formulate decision support systems. REPORTING METHOD Consolidated criteria for reporting qualitative research (COREQ). PATIENT OR PUBLIC CONTRIBUTION None.
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Affiliation(s)
- Cecilia Fager
- Department of Ambulance Service, Kalmar County, Kalmar, Sweden
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Andreas Rantala
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Department of Ambulance Service, Region Skåne, Helsingborg, Sweden
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Anders Svensson
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Department of Ambulance Service, Växjö, Sweden
| | - Mats Holmberg
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Anders Bremer
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Växjö, Sweden
- Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
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4
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Ort BBA, Uit Het Broek LG, de Bruin H, Akkermans RP, Goosselink B, Vermeulen H, Ebben RHA, Vloet LCM, Berben SAA. Patient factors associated with conveyance decision-making by Emergency Medical Services professionals in patients with a syncope: a cross-sectional factorial survey design. BMC Emerg Med 2023; 23:118. [PMID: 37798716 PMCID: PMC10557231 DOI: 10.1186/s12873-023-00890-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The clinical decision-making of non-conveyance is perceived as complex and difficult by emergency medical services (EMS) professionals. Patients with a transient loss of consciousness (TLOC) based on syncope constitute a significant part of the non-conveyance population. Risk stratification is the basis of the clinical decision-making process by EMS professionals. This risk stratification is based on various patient factors. This study aimed to explore patient factors significantly associated with conveyance decision-making by EMS professionals in patients with a TLOC based on syncope. METHODS A cross-sectional vignette study with a factorial survey design was conducted. Patient factors were derived from the "National Protocol Ambulance Care", and all possible combinations of these factors and underlying categories were combined, resulting in 256 unique vignettes (2*4*4*4*2 = 256). Patient factors presented either low-risk or high-risk factors for adverse events. Data were collected through an online questionnaire, in which participants received a random sample of 15 vignettes. For each vignette, the respondent indicated whether the patient would need to be conveyed to the emergency department or not. A multilevel logistic regression analysis with stepwise backward elimination was performed to analyse factors significantly associated with conveyance decision-making. In the logistic model, we modelled the probability of non-conveyance. RESULTS 110 respondents were included, with 1646 vignettes being assessed. Mean age 45.5 (SD 9.3), male gender 63.6%, and years of experience 13.2 (SD 8.9). Multilevel analysis showed two patient factors contributing significantly to conveyance decision-making: 'red flags' and 'prehospital electrocardiogram (ECG)'. Of these patient factors, three underlying categories were significantly associated with non-conveyance: 'sudden cardiac death < 40 years of age in family history' (OR 0.33, 95% CI 0.22-0.50; p < 0.001), 'cardiovascular abnormalities, pulmonary embolism or pulmonary hypertension in the medical history' (OR 0.62, 95% CI 0.43-0.91; p = 0.01), and 'abnormal prehospital ECG' (OR 0.54, 95% CI 0.41-0.72; p < 0.001). CONCLUSION Sudden cardiac death < 40 years of age in family history, medical history, and abnormal ECG are significantly negatively associated with non-conveyance decision-making by EMS professionals in patients with a TLOC based on syncope. Low-risk factors do not play a significant role in conveyance decision-making.
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Affiliation(s)
- B Bastiaan A Ort
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands.
| | - Lucia G Uit Het Broek
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
| | - Harm de Bruin
- Emergency Medical Service, RAV Utrecht, Utrecht, The Netherlands
| | - Reinier P Akkermans
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Centre , Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Ben Goosselink
- Emergency Medical Service, Ambulance IJsselland, Zwolle, The Netherlands
| | - Hester Vermeulen
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Centre , Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Remco H A Ebben
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Emergency Medical Service, Public Health and Safety region Gelderland-Midden, Arnhem, The Netherlands
| | - Lilian C M Vloet
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Centre , Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Sivera A A Berben
- School of Health Studies, Research Department of Emergency and Critical Care, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare, Radboud University Medical Centre , Nijmegen, The Netherlands
- Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, The Netherlands
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Ivic R, Vicente V, Kurland L, Svensson J, Sahdev Klintemård R, Castrén M, Bohm K. Pre-hospital emergency nurse specialist's experiences in caring for patients with non-specific chief complaints in the ambulance - A qualitative interview study. Int Emerg Nurs 2022; 63:101178. [PMID: 35738055 DOI: 10.1016/j.ienj.2022.101178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 04/05/2022] [Accepted: 05/04/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pre-hospital emergency nurse (PEN) specialists are faced with patients presenting with non-specific chief complaints (NSC) to the emergency medical service (EMS) on a daily basis. These patients are often elderly and one in three has a serious condition and their acuity is not recognized. OBJECTIVE The aim of the current study was to explore PEN specialists' experiences in caring for patients presenting with non-specific chief complaints. DESIGN A qualitative study design with eleven individual interviews of PENs, between 2018 and 2020. Qualitative content analysis was used. RESULTS The analyses generated three categories including subcategories. The categories were "Unexplained suffering". "Systematic approach and experience enhances medical safety". "Organizational processes can be optimized". The relation between the categories compiled as ́In-depth systematic assessment is perceived to reduce suffering and increases patient safetý. CONCLUSION The PENs experiences in caring for patients presenting with non-specific chief complaints show that an in-depth systematic assessment may lead to a meaningful caring encounter which enables the identification of the cause of the chief complaint. Experience and a systematic approach were considered as essential to enhance medical safety. This could be strengthened through feedback on the nurse's care provided by care managers and employers. To optimize organizational processes, the development of the opportunity to convey the patient to different levels of care can be an important component.
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Affiliation(s)
- R Ivic
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Academic Emergency Medical Service, Region Stockholm, Stockholm, Sweden.
| | - V Vicente
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden.
| | - L Kurland
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Örebro University, Department for Medical Sciences, Örebro, Sweden.
| | | | | | - M Castrén
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Emergency Medicine, Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland.
| | - K Bohm
- Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden; Department of Emergency Medicine, Södersjukhuset, Stockholm, Sweden.
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Larsson G, Dagerhem A, Wihlborg J, Rantala A. Satisfaction among non-conveyed patients and significant others when discharged at the scene by the ambulance service: an exploratory cross-sectional survey. BMC Emerg Med 2022; 22:100. [PMID: 35672702 PMCID: PMC9171931 DOI: 10.1186/s12873-022-00659-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background The ambulance service is facing an increased number of calls and ambulance assignments. Between 12 and 42% of all assignments result in non-conveyance to the Accident and Emergency Department. However, there is limited knowledge regarding satisfaction among patients and significant others when patients are assessed as non-urgent and discharged at the scene. Therefore, the aim of the study was to explore and compare satisfaction with the ambulance service among patients and significant others when the patient was discharged at the scene. Methods The present study was designed as a cross-sectional exploratory survey with a consecutive sample employing the Consumer Emergency Care Satisfaction Scale questionnaire on patients and significant others. Results A total of 162 questionnaires were analysed, 87 patients and 75 significant others. Overall, satisfaction was high with no significant difference between patients and significant others, although 17-19% were dissatisfied with the discharge information. Conclusions Generally, patients and significant others are satisfied with the care provided by the Ambulance Service when discharged at the scene and thus not conveyed the Accident and Emergency Department. The participants were especially satisfied with Specialist Ambulance Nurses’ interpersonal skills, e.g., making time and providing thorough information. Guidelines for assignments involving non-conveyance, as well as information, instructions and what to expect when discharged at the scene can be improved.
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Affiliation(s)
- Glenn Larsson
- PreHospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.,Department of Prehospital Emergency Care, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Alma Dagerhem
- Emergency Department, Halland Hospital, Halmstad, Sweden
| | - Jonas Wihlborg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Andreas Rantala
- Emergency Department, Helsingborg General Hospital, Helsingborg, Sweden. .,Department of Health Sciences, Lund University, P.O. Box 157, SE-221 00, Lund, Sweden. .,Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University, Växjö, Sweden.
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Magnusson C, Hagiwara MA, Norberg-Boysen G, Kauppi W, Herlitz J, Axelsson C, Packendorff N, Larsson G, Wibring K. Suboptimal prehospital decision- making for referral to alternative levels of care - frequency, measurement, acceptance rate and room for improvement. BMC Emerg Med 2022; 22:89. [PMID: 35606694 PMCID: PMC9125920 DOI: 10.1186/s12873-022-00643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 05/05/2022] [Indexed: 11/15/2022] Open
Abstract
Background The emergency medical services (EMS) have undergone dramatic changes during the past few decades. Increased utilisation, changes in care-seeking behaviour and competence among EMS clinicians have given rise to a shift in EMS strategies in many countries. From transport to the emergency department to at the scene deciding on the most appropriate level of care and mode of transport. Among the non-conveyed patients some may suffer from “time-sensitive conditions” delaying diagnosis and treatment. Thus, four questions arise:How often are time-sensitive cases referred to primary care or self-care advice? How can we measure and define the level of inappropriate clinical decision-making? What is acceptable? How to increase patient safety?
Main text To what extent time-sensitive cases are non-conveyed varies. About 5–25% of referred patients visit the emergency department within 72 hours, 5% are hospitalised, 1–3% are reported to have a time-sensitive condition and seven-day mortality rates range from 0.3 to 6%. The level of inappropriate clinical decision-making can be measured using surrogate measures such as emergency department attendances, hospitalisation and short-term mortality. These measures do not reveal time-sensitive conditions. Defining a scoring system may be one alternative, where misclassifications of time-sensitive cases are rated based on how severely they affected patient outcome. In terms of what is acceptable there is no general agreement. Although a zero-vision approach does not seem to be realistic unless under-triage is split into different levels of severity with zero-vision in the most severe categories. There are several ways to reduce the risk of misclassifications. Implementation of support systems for decision-making using machine learning to improve the initial assessment is one approach. Using a trigger tool to identify adverse events is another. Conclusion A substantial number of patients are non-conveyed, including a small portion with time-sensitive conditions. This poses a threat to patient safety. No general agreement on how to define and measure the extent of such EMS referrals and no agreement of what is acceptable exists, but we conclude an overall zero-vision is not realistic. Developing specific tools supporting decision making regarding EMS referral may be one way to reduce misclassification rates.
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Affiliation(s)
- Carl Magnusson
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, SE-405 30, Gothenburg, Sweden. .,Department of Prehospital Emergency Care , Sahlgrenska University Hospital, SE-411 04, Gothenburg, Sweden.
| | - Magnus Andersson Hagiwara
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Gabriella Norberg-Boysen
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Wivica Kauppi
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Johan Herlitz
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Christer Axelsson
- Department of Prehospital Emergency Care , Sahlgrenska University Hospital, SE-411 04, Gothenburg, Sweden.,Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Niclas Packendorff
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Glenn Larsson
- Prehospen-Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare, University of Borås, SE-501 90, Borås, Sweden
| | - Kristoffer Wibring
- Department of Ambulance and Prehospital Care, Region Halland, SE-302 49, Halmstad, Sweden
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Forsgärde ES, Svensson A, Rööst M, Fridlund B, Elmqvist C. The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called. Int J Qual Stud Health Well-being 2021; 16:1970095. [PMID: 34427535 PMCID: PMC8386744 DOI: 10.1080/17482631.2021.1970095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Purpose This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and primary healthcare (PHC) centre personnel. Methods The study used a phenomenological reflective lifeworld research (RLR) approach. Participants included in three specific situations with extended collaboration were interviewed: three older patients, one significant other, three ambulance personnel and four personnel at the PHC centre. The transcribed interviews were analysed for meanings of the phenomenon. Results The extended collaboration means that decisions were supported through dialogue by bridging knowledge spaces between person, within-team and across-team levels. Through dialogue experience and knowledge were shared and certainty in decisions was increased. The extended collaboration was built on trust, responsibility taken, shared and entrusted, and the common goal of adapted care for the unique patient. A need for further improvement and transparency was elucidated. Conclusions The difficulty of making care decisions stresses the importance of available extended collaboration based on the dialogue between patients, significant others, and ambulance- and PHC centre personnel to increase certainty in decisions. Collaboration further requires respectful encounters, trust, responsibility and a common goal of adapting the care for the unique patient.
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Affiliation(s)
- Elin-Sofie Forsgärde
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency Care CICE, Linnaeus University, Växjö, Sweden
| | - Anders Svensson
- Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.,Centre of Interprofessional Collaboration within Emergency Care CICE, Linnaeus University, Växjö, Sweden.,Ambulance Service, Region Kronoberg, Växjö, Sweden
| | - Mattias Rööst
- Department for Research and Development, Region Kronoberg, Växjö, Sweden.,Department of Clinical Sciences in Malmö, Family Medicine, Lund University, Malmö, Sweden
| | - Bengt Fridlund
- Centre of Interprofessional Collaboration within Emergency Care CICE, Linnaeus University, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Collaboration within Emergency Care CICE, Linnaeus University, Växjö, Sweden.,Department for Research and Development, Region Kronoberg, Växjö, Sweden
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9
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Forsgärde ES, Elmqvist C, Fridlund B, Svensson A, Andersson R, Rööst M. Patients' aged ≥65 years dispositions during ambulance assignments, including factors associated with non-conveyance to hospital: a longitudinal and comparative study. BMJ Open 2020; 10:e038885. [PMID: 33243795 PMCID: PMC7692831 DOI: 10.1136/bmjopen-2020-038885] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES Patients ≥65 years old represent 30%-50% of all ambulance assignments (AAs), and the knowledge of which care level they are disposed to is limited and diverging. The aim of this study was therefore to describe and compare characteristics of patients' aged ≥65 years dispositions during AA, including determining changes over time and factors associated with non-conveyance to hospitals. DESIGN A longitudinal and comparative database study. SETTING Ambulance service in a Swedish region. PARTICIPANTS 32 085 AAs with patients ≥65 years old during the years 2014, 2016 and 2018. EXCLUSION CRITERIA AAs with interhospital patient transfers and lack of patients' dispositions data. OUTCOME MEASURES Dependent factors: conveyance and non-conveyance to hospitals. Independent factors: age, sex, symptom, triage level, scene, time, day and season. RESULTS The majority (n=29 060; 90.6%) of patients' dispositions during AA were conveyance to hospitals. In total, the most common symptoms were circulatory (n=4953; 15.5%) and respiratory (n=4529; 14.1%). A significant increase, p<0.01, of non-conveyance to hospitals was shown during 2014 and 2018, from 801 (7.8%) to 1295 (11.4%). Increasing age was associated with decreasing odds of non-conveyance, 85-89 years (OR=0.85, 95 % CI=0.72 to 0.99) and 90 years or older (OR=0.80, 95 % CI=0.68 to 0.93). Several factors were associated with non-conveyance, for example, symptoms of diabetes (OR=8.57, 95 % CI=5.99 to 12.26) and mental disorders (OR=5.71, 95 % CI=3.85 to 8.48) in comparison with infections. CONCLUSIONS The study demonstrates several patient characteristics, and factors associated with non-conveyance to hospitals, such as age, symptom, triage level, scene, time, day and season. The increasing non-conveyance trend highlights the importance of further studies on optimal care levels for patients ≥65 years old.
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Affiliation(s)
- Elin-Sofie Forsgärde
- Health and Caring Science, Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
| | - Carina Elmqvist
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
- Department for Research and Development, Region Kronoberg, Växjö, Sweden
| | - Bengt Fridlund
- Centre of Interprofessional Cooperation within Emergency Care (CICE), Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
| | - Anders Svensson
- Health and Caring Science, Linnaeus University Faculty of Health and Life Sciences, Växjö, Sweden
- Ambulance Service, Region Kronoberg, Växjö, Sweden
| | | | - Mattias Rööst
- Department for Research and Development, Region Kronoberg, Växjö, Sweden
- Clinical Sciences Malmö, Lund University, Lund, Sweden
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