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Berg, L. M., Ehrenberg, A., Florin, J., Östergren, J., Discacciati, A. & Göransson, K. E. (2019). Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels without need of acute hospital care on departure from the emergency department. Annals of Emergency Medicine, 74(3), 345-356
Open this publication in new window or tab >>Associations between crowding and ten-day mortality among patients allocated lower triage acuity levels without need of acute hospital care on departure from the emergency department
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2019 (English)In: Annals of Emergency Medicine, ISSN 0196-0644, E-ISSN 1097-6760, Vol. 74, no 3, p. 345-356Article in journal (Refereed) Published
Abstract [en]

STUDY OBJECTIVE: We describe the association between emergency department (ED) crowding and 10-day mortality for patients triaged to lower acuity levels at ED arrival and without need of acute hospital care on ED departure.

METHODS: This was a registry study based on ED visits with all patients aged 18 years or older, with triage acuity levels 3 to 5, and without need of acute hospital care on ED departure during 2009 to 2016 (n=705,699). The sample was divided into patients surviving (n=705,076) or dying (n=623) within 10 days. Variables concerning patient characteristics and measures of ED crowding (mean length of stay and ED occupancy ratio) were extracted from the hospital's electronic health records. ED length of stay per ED visit was estimated by the average length of stay for all patients who presented to the ED during the same day and shift and with the same acuity level. The 10-day mortality after ED discharge was used as the outcome measure. Multivariable logistic regression analyses were conducted.

RESULTS: The 10-day mortality rate was 0.09% (n=623). The event group had larger proportions of patients aged 80 years or older (51.4% versus 7.7%) and triaged with acuity level 3 (63.3% versus 35.6%), and greater comorbidity (age-combined Charlson comorbidity index median interquartile range 6 versus 0). We observed an increased 10-day mortality for patients with a mean ED length of stay greater than or equal to 8 hours versus less than 2 hours (adjusted odds ratio 5.86; 95% confidence interval [CI] 2.15 to 15.94) and for elevated ED occupancy ratio. Adjusted odds ratios for ED occupancy ratio quartiles 2, 3, and 4 versus quartile 1 were 1.48 (95% CI 1.14 to 1.92), 1.63 (95% CI 1.24 to 2.14), and 1.53 (95% CI 1.15 to 2.03), respectively.

CONCLUSION: Patients assigned to lower triage acuity levels when arriving to the ED and without need of acute hospital care on departure from the ED had higher 10-day mortality when the mean ED length of stay exceeded 8 hours and when ED occupancy ratio increased.

National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30483 (URN)10.1016/j.annemergmed.2019.04.012 (DOI)000482210700011 ()31229391 (PubMedID)2-s2.0-85067334196 (Scopus ID)
Available from: 2019-06-27 Created: 2019-06-27 Last updated: 2019-09-20Bibliographically approved
Kislov, R., Wilson, P., Cummings, G., Ehrenberg, A., Gifford, W., Kelly, J., . . . Harvey, G. (2019). From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries. PAR. Public Administration Review, 79(5), 684-698
Open this publication in new window or tab >>From Research Evidence to “Evidence by Proxy”?: Organizational Enactment of Evidence-Based Health Care in Four High-Income Countries
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2019 (English)In: PAR. Public Administration Review, ISSN 0033-3352, E-ISSN 1540-6210, Vol. 79, no 5, p. 684-698Article in journal (Refereed) Published
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30082 (URN)10.1111/puar.13056 (DOI)000483717900007 ()2-s2.0-85065200893 (Scopus ID)
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-09-20Bibliographically approved
Harvey, G., Gifford, W., Cummings, G., Kelly, J., Kislov, R., Kitson, A., . . . Ehrenberg, A. (2019). Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries. International Journal of Nursing Studies, 90, 21-30
Open this publication in new window or tab >>Mobilising evidence to improve nursing practice: A qualitative study of leadership roles and processes in four countries
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2019 (English)In: International Journal of Nursing Studies, ISSN 0020-7489, E-ISSN 1873-491X, Vol. 90, p. 21-30Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved.

OBJECTIVES: The aim of the study was to enhance understanding of the mechanisms by which key nursing roles lead the implementation of evidence-based practice across different care settings and countries and the contextual factors that influence them.

DESIGN: The study employed a qualitative descriptive approach.

SETTINGS: Data collection was undertaken in acute care and primary/community health care settings in Australia, Canada, England and Sweden.

PARTICIPANTS: 55 individuals representing different levels of the nursing leadership structure (executive to frontline), roles (managers and facilitators), sectors (acute and primary/community) and countries.

METHODS: Individual semi-structured interviews were conducted with all participants exploring their roles and experiences of leading evidence-based practice. Data were analysed through a process of qualitative content analysis.

RESULTS: Different countries had varying structural arrangements and roles to support evidence-based nursing practice. At a cross-country level, three main themes were identified relating to different mechanisms for enacting evidence-based practice, contextual influences at a policy, organisational and service delivery level and challenges of leading evidence-based practice.

CONCLUSIONS: National policies around quality and performance shape priorities for evidence-based practice, which in turn influences the roles and mechanisms for implementation that are given prominence. There is a need to maintain a balance between the mechanisms of managing and monitoring performance and facilitating critical questioning and reflection in and on practice. This requires a careful blending of managerial and facilitative leadership. The findings have implications for theory, practice, education and research relating to implementation and evidence-based practice.

Keywords
Evidence-based practice, Facilitation, Facilitators, Implementation, Knowledge translation, Leadership, Managers
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29100 (URN)10.1016/j.ijnurstu.2018.09.017 (DOI)000461265700005 ()30551080 (PubMedID)2-s2.0-85058064165 (Scopus ID)
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-03-28Bibliographically approved
Koistinen, S., Olai, L., Ståhlnacke, K., Anna, F. & Ehrenberg, A. (2019). Oral health and oral care in short-term care: prevalence, related factors, and coherence between older peoples and professionals assessments. Scandinavian Journal of Caring Sciences, 33(3), 712-722
Open this publication in new window or tab >>Oral health and oral care in short-term care: prevalence, related factors, and coherence between older peoples and professionals assessments
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2019 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 33, no 3, p. 712-722Article in journal (Refereed) Published
Abstract [en]

Background: Oral health is important for well-being and overall health. Older peoples oral health is well described in the residential care context, but remains understudied in short-term care.

Objective: The aim of this study was to describe oral health, daily oral care and related factors among older people in short-term care and to compare self-perceived oral health with professional assessment.

Materials and methods: This cross-sectional study included 391 older people in 36 short-term units in 19 Swedish municipalities. Oral health was assessed professionally by clinical oral assessment and the Revised Oral Assessment Guide (ROAG). The older peoples’ perceptions of their own oral health were measured with a global question on self-perceived oral health. Self-care ability was assessed with Katz Index of Activities of Daily Living (Katz-ADL).

Results: Mean age was 82.9 years, 19% of participants were totally edentulous, and 43% had ≥20 teeth. Almost 60% had coating or food debris on their teeth, but only 19% received help with daily oral care. Those who were dependent on help with self-care had around a sixfold higher risk of having oral problems. There was a low level of agreement between the clinical assessment based on ROAG and self-perceived oral health.

Conclusion: Professionals’ assessments of oral health differed considerably from the older peoples own assessments. A higher risk of oral problems and more occurrence of coating or food debris or broken teeth were seen among those dependent on help with self-care (ADL). This study indicates that in order to improve older peoples oral health and oral care we need to provide person-centred oral care and to develop a close collaboration between nursing and dental staff.

Keywords
oral health, oral care, older people, short-term care, self-perceived, functional ability
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29647 (URN)10.1111/scs.12667 (DOI)000486090000021 ()30859599 (PubMedID)2-s2.0-85062833660 (Scopus ID)
Note

Open Access beslut 5/2019

Available from: 2019-03-12 Created: 2019-03-12 Last updated: 2019-10-07Bibliographically approved
Berg, L. M., Ehrenberg, A., Florin, J., Östergren, J. & Göransson, K. E. (2019). Significant changes in emergency department length of stay and case mix over eight years at a large Swedish University Hospital. International Emergency Nursing, 43, 50-55
Open this publication in new window or tab >>Significant changes in emergency department length of stay and case mix over eight years at a large Swedish University Hospital
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2019 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 43, p. 50-55Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Describe the longitudinal development of crowding and patient/emergency department (ED) characteristics at a Swedish University Hospital.

METHODS: A retrospective longitudinal registry study based on all ED visits with adult patients during 2009-2016 (N = 1,063,806). Patient characteristics and measures of ED crowding (ED occupancy ratio, length-of-stay [LOS], patients/clinician's ratios) were extracted from the hospital's electronic health record. Non-parametric analyses were conducted.

RESULTS: The proportion of unstable patients (triage level 1-2) increased while the proportion of admitted patients decreased. All crowding variables were stable, except for LOS, which increased by 9 min/visit/year (95% CI: 8.8-9.1). LOS for visits by patients ≥ 80 years increased more compared to those 18-79 (248 min vs. 190 min, p < 0.001). Unstable patients increased their median LOS compared to stable patients (triage level 3-5). LOS for discharged patients increased with an average of 7.7 min/year (95% CI: 7.5-7.9) compared to 15.5 min/year (95% CI: 15.2-15.8) for those being admitted.

CONCLUSION: Fewer admissions, despite an increase of unstable patients, is likely related to lack of in-hospital beds and contributes to ED crowding. The increase in median ED LOS, especially for patients in the subgroups unstable, ≥80 years and admitted to in-hospital care reflects this problem.

Keywords
Clinicians, Crowding, Emergency department, Health policy, Patient safety, Physician, Quantitative, Registered nurse, Work environment
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28476 (URN)10.1016/j.ienj.2018.08.001 (DOI)000460680600009 ()30190224 (PubMedID)2-s2.0-85052831113 (Scopus ID)
Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2019-03-28Bibliographically approved
Göras, C., Olin, K., Unbeck, M., Pukk-Härenstam, K., Ehrenberg, A., Tessma, M. K., . . . Ekstedt, M. (2019). Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study.. BMJ Open, 9(5), Article ID e026410.
Open this publication in new window or tab >>Tasks, multitasking and interruptions among the surgical team in an operating room: a prospective observational study.
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 5, article id e026410Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The work context of the operating room (OR) is considered complex and dynamic with high cognitive demands. A multidimensional view of the complete preoperative and intraoperative work process of the surgical team in the OR has been sparsely described. The aim of this study was to describe the type and frequency of tasks, multitasking, interruptions and their causes during surgical procedures from a multidimensional perspective on the surgical team in the OR.

DESIGN: Prospective observational study using the Work Observation Method By Activity Timing tool.

SETTING: An OR department at a county hospital in Sweden.

PARTICIPANTS: OR nurses (ORNs) (n=10), registered nurse anaesthetists (RNAs) (n=8) and surgeons (n=9).

RESULTS: The type, frequency and time spent on specific tasks, multitasking and interruptions were measured. From a multidimensional view, the surgical team performed 64 tasks per hour. Communication represented almost half (45.7%) of all observed tasks. Concerning task time, direct care dominated the surgeons' and ORNs' intraoperative time, while in RNAs' work, it was intra-indirect care. In total, 48.2% of time was spent in multitasking and was most often observed in ORNs' and surgeons' work during communication. Interruptions occurred 3.0 per hour, and the largest proportion, 26.7%, was related to equipment. Interruptions were most commonly followed by professional communication.

CONCLUSIONS: The surgical team constantly dealt with multitasking and interruptions, both with potential impact on workflow and patient safety. Interruptions were commonly followed by professional communication, which may reflect the interactions and constant adaptations in a complex adaptive system. Future research should focus on understanding the complexity within the system, on the design of different work processes and on how teams meet the challenges of a complex adaptive system.

TRIAL REGISTRATION NUMBER: 2016/264.

Keywords
complexity, interruptions, multitasking, operating room, patient safety
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-30086 (URN)10.1136/bmjopen-2018-026410 (DOI)000471192800188 ()31097486 (PubMedID)2-s2.0-85065927356 (Scopus ID)
Available from: 2019-05-22 Created: 2019-05-22 Last updated: 2019-07-04Bibliographically approved
Westgård, T., Ottenvall Hammar, I., Holmgren, E., Ehrenberg, A., Wisten, A., Ekdahl, A. W., . . . Wilhelmson, K. (2018). Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital: a feasibility study. Pilot and Feasibility Studies, 4, Article ID 41.
Open this publication in new window or tab >>Comprehensive geriatric assessment pilot of a randomized control study in a Swedish acute hospital: a feasibility study
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2018 (English)In: Pilot and Feasibility Studies, ISSN 2055-5784, Vol. 4, article id 41Article in journal (Refereed) Published
Abstract [en]

Background: Comprehensive geriatric assessment (CGA) represent an important component of geriatric acute hospital care for frail older people, secured by a multidisciplinary team who addresses the multiple needs of physical health, functional ability, psychological state, cognition and social status. The primary objective of the pilot study was to determine feasibility for recruitment and retention rates. Secondary objectives were to establish proof of principle that CGA has the potential to increase patient safety.

Methods: The CGA pilot took place at a University hospital in Western Sweden, from March to November 2016, with data analyses in March 2017. Participants were frail people aged 75 and older, who required an acute admission to hospital. Participants were recruited and randomized in the emergency room. The intervention group received CGA, a person-centered multidisciplinary team addressing health, participation, and safety. The control group received usual care. The main objective measured the recruitment procedure and retention rates. Secondary objectives were also collected regarding services received on the ward including discharge plan, care plan meeting and hospital risk assessments including risk for falls, nutrition, decubitus ulcers, and activities of daily living status.

Result: Participants were recruited from the emergency department, over 32 weeks. Thirty participants were approached and 100% (30/30) were included and randomized, and 100% (30/30) met the inclusion criteria. Sixteen participants were included in the intervention and 14 participants were included in the control. At baseline, 100% (16/16) intervention and 100% (14/14) control completed the data collection. A positive propensity towards the secondary objectives for the intervention was also evidenced, as this group received more care assessments. There was an average difference between the intervention and control in occupational therapy assessment - 0.80 [95% CI 1.06, - 0.57], occupational therapy assistive devices - 0.73 [95% CI 1.00, - 0.47], discharge planning -0.21 [95% CI 0.43, 0.00] and care planning meeting 0.36 [95% CI-1.70, -0.02]. Controlling for documented risk assessments, the intervention had for falls - 0.94 [95% CI 1.08, - 0.08], nutrition - 0.87 [95% CI 1.06, - 0.67], decubitus ulcers - 0.94 [95% CI 1.08, - 0.80], and ADL status - 0.80 [95% CI 1.04, - 0.57].

Conclusion: The CGA pilot was feasible and proof that the intervention increased safety justifies carrying forward to a large-scale study.

Trial registration: Clinical Trials ID: NCT02773914. Registered 16 May 2016.

Keywords
Discharge plan, Frail older people, Geriatric, Multidisciplinary team, Occupational therapy, Safety
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-27208 (URN)10.1186/s40814-018-0228-1 (DOI)29423259 (PubMedID)2-s2.0-85046787910 (Scopus ID)
Available from: 2018-02-14 Created: 2018-02-14 Last updated: 2018-05-28Bibliographically approved
Bjurbo, C., Eriksson, U., Källberg, A.-S., Ehrenberg, A. & Muntlin Athlin, Å. (2018). Early identification of frail older patients by using the FRESH-instrument in the emergency department: a pilot study. In: : . Paper presented at 3rd Global Conference on Emergency Nursing & Trauma Care, Leeuwenhorst, 6-8 October 2018.
Open this publication in new window or tab >>Early identification of frail older patients by using the FRESH-instrument in the emergency department: a pilot study
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2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare, Tidig identifiering av sköra äldre på akutmottagning
Identifiers
urn:nbn:se:du-29205 (URN)
Conference
3rd Global Conference on Emergency Nursing & Trauma Care, Leeuwenhorst, 6-8 October 2018
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2019-09-25Bibliographically approved
Kislov, R., Cummings, G., Ehrenberg, A., Gifford, W., Harvey, G., Kitson, A., . . . Wilson, P. (2018). From research evidence to "evidence by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries. In: : . Paper presented at Evidence Live Symposium, Oxford UK.
Open this publication in new window or tab >>From research evidence to "evidence by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries
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2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29207 (URN)
Conference
Evidence Live Symposium, Oxford UK
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2018-12-27Bibliographically approved
Kislov, R., Cummings, G., Ehrenberg, A., Gifford, W., Harvey, G., Kitson, A., . . . Wilson, P. (2018). From research evidence to "research by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries. In: : . Paper presented at International Organizational Behavior in Healthcare Conference, Montreal, May 13-16 2018.
Open this publication in new window or tab >>From research evidence to "research by proxy"?: Organisational enactment of evidence-based healthcare in four high-income countries
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2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29208 (URN)
Conference
International Organizational Behavior in Healthcare Conference, Montreal, May 13-16 2018
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2018-12-27Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3964-196X

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