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  • 1.
    Norberg Boysen, Gabriella
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Christensson, Lennart
    Jönköping University, Department of Nursing, School of Health Sciences.
    Jutengren, Göran
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Patient trust and patient safety for low-priority patients: A randomized controlled trial pilot study in the prehospital chain of care.2019Ingår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 46, artikel-id 100778Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Patients who call for an ambulance but only have primary care needs do not always get appropriate care. The starting point in this study is that such patients should be assigned to as basic of care as possible, while maintaining high levels of patient trust and patient safety.

    AIM: To evaluate patient trust and patient safety among low-priority ambulance patients referred to care at either the Community Health Centre (CHC) or the Emergency Department (ED).

    METHODS: This randomized controlled trial pilot study compared the level of patient trust and patient safety among low-priority ambulance patients who were randomized into two groups: CHC (n = 105) or ED (n = 83).

    RESULTS: There was a high level of trust in the care received, regardless of whether the patient received care at CHC or ED. Overall 31% fulfilled one or more of the given criteria for potentially jeopardizing patient safety.

    CONCLUSION: Patient selection for the trial indicated a potential limit in patient safety. There was a high level of trust in the care received regardless of whether the patient received care. The accuracy of patient selection for the new care model needs to be further improved with the intention to enhance patient safety even further.

  • 2.
    Tärnqvist, Julia
    et al.
    The Ambulance Service in Skaraborg, Lidköping, Sweden.
    Dahlén, Erik
    The Ambulance Service in Skaraborg, Lidköping, Sweden.
    Magnusson, Carl
    Sahlgrenska Univ Hospital.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Strömsöe, Anneli
    University of Dalarna.
    Norberg, Gabriella
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Axelsson, Christer
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd. Sahlgrenska University Hospital.
    Andersson Hagiwara, Magnus
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions2017Ingår i: Prehospital and Disaster Medicine, ISSN 1049-023X, E-ISSN 1945-1938, Vol. 32, nr 5, s. 528-535Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction The use of Emergency Medical Services (EMS) is increasing. A number of patients call repeatedly for EMS. Early studies of frequent callers show that they form a heterogenous group. Problem There is a lack of research on frequent EMS callers. There is furthermore a lack of knowledge about characteristics and the prehospital assessment of the patients who call for EMS on several occasions. Finally, there is a general lack of knowledge with regard to the association between the prehospital assessment by health care providers and the final diagnosis. Method Patients in Skaraborg in Western Sweden, who used the EMS at least four times in 2014, were included, excluding transport between hospitals. Information on the prehospital assessment on-scene and the final diagnosis was collected from the EMS and hospital case records. Results In all, 339 individual patients who used the EMS on 1,855 occasions were included, accounting for five percent of all missions. Fifty percent were women. The age range was 10-98 years, but more than 50.0% were in the age range of 70-89 years. The most common emergency signs and symptoms (ESS) codes on the scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease (eight percent). Thirteen percent of all cases had a final diagnosis defined as a potentially life-threatening condition. Among these, 22.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Forty-nine percent had a defined final diagnosis not fulfilling the criteria for a potentially life-threatening condition. Among these cases, 30.0% of prehospital assessments were retrospectively judged as potentially inappropriate. Conclusion: Among patients who used EMS on multiple occasions, the most common symptoms on-scene were dyspnea, chest pain, and abdominal pain. The most common final diagnosis was chronic obstructive pulmonary disease. In 13.0%, the final diagnosis of a potentially life-threatening condition was indicated. In a minority of these cases, the assessment on-scene was judged as potentially inappropriate. Tärnqvist J , Dahlén E , Norberg G , Magnusson C , Herlitz J , Strömsöe A , Axelsson C , Andersson Hagiwara M . On-Scene and Final Assessments and Their Interrelationship Among Patients Who Use the EMS on Multiple Occasions. Prehosp Disaster Med. 2017;32(5):1–8.

  • 3. Norberg Boysen, Gabriella
    Patientens tillit till den prehospitala vårdkedjan: Ändamålsenlig vårdnivå för patienter med primärvårdsbehov2017Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Aim: The overall aim of the thesis is to investigate whether a new care-model can be introduced – in which patients with primary care needs and not in need of hospital emergency department care can be referred directly to a healthcare centre – and respond to the patient’s need of trust and patient safety.  

    Methods: The four sub studies employ different methods: three are quantitative with varying approaches and one is qualitative. Sub study I is a retrospective explorative register study aimed to identify characteristics and frequency. Sub study II is an instrument development study aimed to measure patient trust. Sub study III is a randomized controlled trial, which compared the level of patient trust and patient-safety among low-priority ambulance patients who were randomized into two groups: the experimental group (care at the healthcare centre) and the control group (traditional care at Emergency department). Finally, sub study IV is a hermeneutic lifeworld study based on interviews with patients who participated in the new care model.  

    Main results: Sixteen percent of the patients to whom an ambulance was allocated could have received care at a healthcare centre instead of an emergency department. They were slightly younger and healthier as regards their histories, but were found at all priority levels and with almost all symptom codes. Patient trust in care did not differ regardless of whether they were cared for at a healthcare centre or at the emergency department. However, 59 patients of 188 overall (31%) fulfilled one or more of the given criteria for potentially reduced patient safety. The phenomenon of trust does not automatically involve medical care. However, attention to the patient’s lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the “voice of lifeworld” enables the patient to feel trust. 

    Conclusion: One in six patients allotted an ambulance may get taken to primary care instead of the hospital emergency department. These patients are found at all priority levels and in most of the symptom codes.  An instrument has been developed that measures patient trust in the prehospital chain of care (Study I). The instrument has proved to be useful in this patient group and is based on two dimensions: Credibility and Accessibility (Study II). Patients’ trust in the prehospital care chain proved to be high and bore no relation to where they received care. Patient safety, on the other hand, appeared to be limited in view of the fact that an excessive proportion of patients were exposed to potential patient safety risks (Study III). Communication that appeals to a patient's lifeworld increases the opportunities for understanding and participation. In all, lifeworld communication creates trust in care at the right level of care as well as in care relationships and the healthcare environment (Study IV). 

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  • 4.
    Norberg Boysen, Gabriella
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Nyström, Maria
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Christensson, Lennart
    Jönköpings universitet.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Trust in the early chain of healthcare: lifeworld hermeneutics from the patient's perspective2017Ingår i: International Journal of Qualitative Studies on Health and Well-being, ISSN 1748-2623, E-ISSN 1748-2631, Vol. 12, nr 1Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: Patients must be able to feel as much trust for caregivers and the healthcare system at the healthcare centre as at the emergency department. The aim of this study is to explain and understand the phenomenon of trust in the early chain of healthcare, when a patient has called an ambulance for non-urgent condition and been referred to the healthcare centre.

    Method: A lifeworld hermeneutic approach from the perspective of caring science was used. Ten patient participated: seven female and three male. The setting is the early chain of healthcare in south-wetern Sweden.

    Results: The findings show that the phenomenon of trust does not automatically involve medical care. However, attention to the patient's lifeworld in a professional caring relationship enables the patient to trust the caregiver and the healthcare environment. It is clear that the "voice of lifeworld" enables the patient to feel trust.

    Conclusion: Trust in the early chain of healthcare entails caregivers' ability to play attention to both medical and existentioal issues in compliance with the patient's information and questions. Thus, the patient must be invited to participate in assessment and decisions concerning his or her own healthcare, in a credible manner and using everyday language.

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  • 5.
    Norberg Boysen, Gabriella
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Christensson, Lennart
    Department of Nursing, Jönköping University, Jönköping, Sweden.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Nyström, Maria
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Jutengren, Göran
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Use of the Medical emergency services by patients with suspected acte primary healthcare problems: Developing av questionnaire measure patient trust in healthcare2016Ingår i: European Journal for Person Centered Healthcare, ISSN 2052-5648, E-ISSN 2052-5656, Vol. 4, nr 3, s. 444-452Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale aims and objectives: The objective of this study was to develop a questionnaire measuring the level of trust and its constituents in patients calling the Emergency Medicak Services (EMS) for suspected acute primary healthcare problems. The questionnaire is called the Patient Trust Questionnaire (PTQ). The following frontline service providers were involved: 1) The Dispatch Centre, 2) the Emergency Medical Services and 3) the recieving unit (the Emergency Department/Healthcare Centre)

    Method: Cross-sectional data were collected repeately and redundant items were discarded using a step-by-step approach. Based on litterature review, the PTQ was developed in line with the folowing 4-step procedure: 1) item construction, 2) a face-to-face evaluation of separate items, 3) an emerical pre-evaluation targeting each separate frontline service provider and 4) an emperical full-scale evaluation. The inclusion criteria for participating were that the patient must be 18 years of age or older and suspected having a suspected acute primary care problem when calling the EMS. In the finale full-scale evaluation of the questionnaire, 427 patients were included.

    Results: A set of 8 items with good phsycometric properties remained through the developing procedure. Two constituents of trust emerged (labelled credibility and accessibility), witch were robust across all fronline service providers.

    Conclusion: A new measuring instrument has been developed for this particular healthcare chain, for patients with suspected acute primary care problem calling the EMS. Althought not yet validated, the PTQ is a potentially usefull tool in future healthcare research with reference to the concept of patient trust.

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  • 6.
    Norberg, Gabriella
    et al.
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Wireklint Sundström, Birgitta
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Christensson, Lennart
    Nyström, Maria
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Herlitz, Johan
    Högskolan i Borås, Akademin för vård, arbetsliv och välfärd.
    Swedish emergency medical services' identification of potential candidates for primary healthcare: Retrospective patient record study.2015Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 33, nr 4, s. 311-317Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: To investigate patients who called the emergency medical services (EMS) for primary healthcare (PHC) problems.

    DESIGN: A retrospective and exploratory patient record study from an EMS perspective, comparing two groups: those who were potential candidates for PHC and those who were not. All data were gathered from EMS and hospital records.

    SETTINGS: The study was completed at the EMS and five hospital areas in the western region of Sweden.

    SUBJECTS: The patients (n = 3001) who called the EMS in 2011. Data were missing for 10%.

    MAIN OUTCOME MEASURES: The frequency and the clinical characteristics of the patients who called the EMS and were actually potential candidates for PHC.

    RESULTS: Of a total of 2703 patients, a group of 426 (16%) were assessed as potential candidates for PHC and could thus be treated at a level of care other than the emergency department. Patients who were classified as suitable for PHC were found at all priority levels and within all symptom groups, but were younger and healthier than the other group.

    CONCLUSION: Numerous patients seeking help from the EMS do not end up at the most appropriate level in the healthcare system.

    IMPLICATIONS: In the EMS, guidelines are needed to enable pre-hospital emergency nurses to assess and triage patients to the most appropriate level of healthcare. Key points Patients calling the emergency medical services do not always end up at an appropriate level of healthcare. In total, 16% of patients were identified by the Swedish emergency medical services as potential candidates for primary healthcare. These patients were younger and healthier than those needing care at the emergency department. They were found at all priority levels and within all symptom groups.

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  • 7.
    Hagiwara, M
    et al.
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Bremer, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Claesson, A
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Axelsson, C
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Norberg, Gabriella
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    Herlitz, J
    Högskolan i Borås, Institutionen för Vårdvetenskap.
    The impact of direct admission to a catheterisation lab/CCU in patients with ST-elevation myocardial infarction on the delay to reperfusion and early risk of death: results of a systematic review including meta-analysis2014Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, ISSN 1757-7241, E-ISSN 1757-7241, Vol. 22, nr 67Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome. Methods Databases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages. The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality. Results Median delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes. In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%. Conclusion An overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.

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