du.sePublications
Change search
Link to record
Permanent link

Direct link
BETA
Florin, Jan
Publications (9 of 9) Show all publications
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
Show others...
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
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
Show others...
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
Nilsson, J., Engström, M., Florin, J., Gardulf, A. & Carlsson, M. (2018). A short version of the nurse professional competence scale for measuring nurses' self-reported competence. Nurse Education Today, 71, 233-239
Open this publication in new window or tab >>A short version of the nurse professional competence scale for measuring nurses' self-reported competence
Show others...
2018 (English)In: Nurse Education Today, ISSN 0260-6917, E-ISSN 1532-2793, Vol. 71, p. 233-239Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The Nurse Professional Competence (NPC) Scale with 88-items has been used to measure self-reported competence among nursing students and registered nurses in many national and international nursing research projects. However, a shorter version of the scale with maintained quality has been requested to further enhance its usability.

OBJECTIVES: To develop and evaluate the construct validity and internal consistency of a shorter version of the NPC Scale.

DESIGN: A developmental and methodological design.

PARTICIPANTS AND SETTINGS: The study was based on a sample of 1810 nursing students at the point of graduation from 12 universities in Sweden.

METHODS: The number of items in the original NPC Scale was reduced using several established research steps and then evaluated for data quality and construct validity using principal component analysis and confirmatory factor analysis. Reliability was measured as internal consistency using Cronbach's alpha.

RESULTS: The extensive process of reducing the number of items resulted in a version with 35 items. Principal component analysis resulted in six factors explaining 53.6% of the variance: "Nursing Care", "Value-based Nursing Care", "Medical and Technical Care", "Care Pedagogics", "Documentation and Administration of Nursing Care", and "Development, Leadership, and Organization of Nursing Care". All factors showed Cronbach's alpha values of >0.70. The confirmative factor analysis goodness-of-fit indexes were for root mean square error of approximation 0.05 and for comparative fit index 0.89.

CONCLUSIONS: The NPC Scale Short Form (NPC Scale-SF) 35-items revealed promising results with a six-factor structure explaining 53.6% of the total variance. This 35-item scale can be an asset when used alone and together with other instruments it can provide the possibility of more complex analyses of self-reported competence among nursing students and registered nurses.

Keywords
Nurses' competence, Nursing education, Nursing students' competence, Professional nursing, Psychometric properties, Validation
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-28820 (URN)10.1016/j.nedt.2018.09.028 (DOI)000452938200038 ()30321851 (PubMedID)2-s2.0-85054740103 (Scopus ID)
Available from: 2018-10-23 Created: 2018-10-23 Last updated: 2019-03-18Bibliographically approved
Berg, L., Ehrenberg, A., Florin, J., Östergren, J. & Göransson, K. (2018). The presence of emergency department crowding at a Swedish University hospital.: A longitudinal study using two crowding indicators as measures.. In: : . Paper presented at 3rd Global Conference on Emergency Nursing & Trauma, Leeuwenhorst, The Netherlands, 6-8 October 2018.
Open this publication in new window or tab >>The presence of emergency department crowding at a Swedish University hospital.: A longitudinal study using two crowding indicators as measures.
Show others...
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-29206 (URN)
Conference
3rd Global Conference on Emergency Nursing & Trauma, Leeuwenhorst, The Netherlands, 6-8 October 2018
Available from: 2018-12-27 Created: 2018-12-27 Last updated: 2018-12-27Bibliographically approved
Källberg, A.-S., Ehrenberg, A., Florin, J., Östergren, J. & Göransson, K. E. (2017). Physicians' and nurses' perceptions of patient safety risks in the emergency department. International Emergency Nursing, 33, 14-19
Open this publication in new window or tab >>Physicians' and nurses' perceptions of patient safety risks in the emergency department
Show others...
2017 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 33, p. 14-19Article in journal (Refereed) Published
Abstract [en]

The emergency department has been described as a high-risk area for errors. It is also known that working conditions such as a high workload and shortage off staff in the healthcare field are common factors that negatively affect patient safety. A limited amount of research has been conducted with regard to patient safety in Swedish emergency departments. Additionally, there is a lack of knowledge about clinicians' perceptions of patient safety risks. Therefore, the purpose of this study was to describe emergency department clinicians' experiences with regard to patient safety risks.

METHOD: Semi-structured interviews were conducted with 10 physicians and 10 registered nurses from two emergency departments. Interviews were analysed by inductive content analysis.

RESULTS: The experiences reflect the complexities involved in the daily operation of a professional practice, and the perception of risks due to a high workload, lack of control, communication and organizational failures.

CONCLUSION: The results reflect a complex system in which high workload was perceived as a risk for patient safety and that, in a combination with other risks, was thought to further jeopardize patient safety. Emergency department staff should be involved in the development of patient safety procedures in order to increase knowledge regarding risk factors as well as identify strategies which can facilitate the maintenance of patient safety during periods in which the workload is high.

Keywords
Emergency service (hospital), Error, Interviews, Patient safety, Qualitative content analysis, Risk
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-24515 (URN)10.1016/j.ienj.2017.01.002 (DOI)28256336 (PubMedID)
Available from: 2017-03-09 Created: 2017-03-09 Last updated: 2017-10-05Bibliographically approved
Florin, J., Bååth, C., Gunningberg, L. & Mårtensson, G. (2016). Attitudes towards pressure ulcer prevention: A psychometric evaluation of the Swedish version of the APuP-instrument. International Wound Journal, 13(5), 655-662
Open this publication in new window or tab >>Attitudes towards pressure ulcer prevention: A psychometric evaluation of the Swedish version of the APuP-instrument
2016 (English)In: International Wound Journal, ISSN 1742-4801, E-ISSN 1742-481X, Vol. 13, no 5, p. 655-662Article in journal (Refereed) Published
Abstract [en]

The primary aim was to conduct a psychometric evaluation of the Attitude towards Pressure ulcer Prevention (APuP) instrument in a Swedish context. A further aim was to describe and compare attitudes towards pressure ulcer prevention between registered nurses (RNs), assistant nurses (ANs) and student nurses (SNs). In total, 415 RNs, ANs and SNs responded to the questionnaire. In addition to descriptive and comparative statistics, confirmatory factor analyses were performed. Because of a lack of support for the instrument structure, further explorative and consecutive confirmatory tests were conducted. Overall, positive attitudes towards pressure ulcer prevention were identified for all three groups, but SNs reported lower attitude scores on three items and a higher score on one item compared to RNs and ANs. The findings indicated no support in this Swedish sample for the previously reported five-factor model of APuP. Further explorative and confirmative factor analyses indicated that a four-factor model was most interpretable: (i) Priority (five items), (ii) Competence (three items), (iii) Importance (three items) and (iv) Responsibility (two items). The five-factor solution could not be confirmed. Further research is recommended to develop a valid and reliable tool to assess nurses' attitudes towards pressure ulcer prevention working across different settings on an international level.

Place, publisher, year, edition, pages
John Wiley & Sons, 2016
Keywords
Attitude; Pressure ulcer prevention; Psychometric validity
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-15504 (URN)10.1111/iwj.12338 (DOI)000387667600061 ()25124833 (PubMedID)
Available from: 2014-09-11 Created: 2014-09-11 Last updated: 2018-04-24Bibliographically approved
Källberg, A.-S., Ehrenberg, A., Florin, J., Östergren, J. & Göransson, K. (2016). Patient safety risks in the emergency department. In: : . Paper presented at 2nd Global Conference on emergency nursing & trauma care. 22-24 September 2016, Sitges, Spain.
Open this publication in new window or tab >>Patient safety risks in the emergency department
Show others...
2016 (English)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Health Sciences
Research subject
Health and Welfare, Patientsäkerhet
Identifiers
urn:nbn:se:du-23745 (URN)
Conference
2nd Global Conference on emergency nursing & trauma care. 22-24 September 2016, Sitges, Spain
Available from: 2016-12-26 Created: 2016-12-26 Last updated: 2016-12-26Bibliographically approved
Berg, L. M., Florin, J., Ehrenberg, A., Östergren, J., Djärv, T. & Göransson, K. E. (2016). Reasons for interrupting colleagues during emergency department work: a qualitative study. International Emergency Nursing, 29(SI), 21-26
Open this publication in new window or tab >>Reasons for interrupting colleagues during emergency department work: a qualitative study
Show others...
2016 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 29, no SI, p. 21-26Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Emergency department team members frequently need to interact with each other, a circumstance causing multiple interruptions. However, information is lacking about the motives underlying these interruptions and this study aimed to explore clinicians' reasons to interrupt colleagues during emergency department work.

METHOD: Semi-structured interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. The interviews were analyzed inductively using content analysis.

RESULTS: The working conditions to some extent sustained the clinicians' need to interrupt, for example different routines. Another reason to interrupt was to improve the initiator's work process, such as when the initiators perceived that the interruption had high clinical relevance. The third reason concerns the desire to influence the work process of colleagues in order to prevent mistakes and provide information for the person being interrupted to improve patient care.

CONCLUSION: The three identified categories for why emergency department clinicians interrupt their colleagues were related to working conditions and a wish to improve/influence the work processes for both initiators and recipients. Several of the reasons given for interrupting colleagues were done in order to improve patient care. Interruptions perceived as negative to the recipient were mostly related to the working conditions.

Keywords
Interruption; Emergency care; Registered nurse; Physician; Clinicians; Work environment; Patient safety
National Category
Health Sciences
Research subject
Health and Welfare
Identifiers
urn:nbn:se:du-22425 (URN)10.1016/j.ienj.2016.06.001 (DOI)000387779100005 ()27339485 (PubMedID)
Available from: 2016-06-27 Created: 2016-06-27 Last updated: 2017-11-28Bibliographically approved
Ehrenberg, A., Berg, L., Källberg, A.-S., Göransson, K., Östergren, J. & Florin, J. (2013). Hur uppfattar personal på akutmottagningar avbrott i arbetet?. In: : . Paper presented at Nationell patientsäkerhetskonferens 2013.
Open this publication in new window or tab >>Hur uppfattar personal på akutmottagningar avbrott i arbetet?
Show others...
2013 (Swedish)Conference paper, Poster (with or without abstract) (Refereed)
National Category
Medical and Health Sciences
Research subject
Health and Welfare, ”Många bollar i luften” – Personalens arbetsmiljö på akutmottagning.
Identifiers
urn:nbn:se:du-13481 (URN)
Conference
Nationell patientsäkerhetskonferens 2013
Available from: 2013-12-10 Created: 2013-12-10 Last updated: 2018-02-14Bibliographically approved
Organisations

Search in DiVA

Show all publications