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  • 1. Amritzer, Maria A
    et al.
    Muntlin, Åsa
    Berg, Lena M
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Göransson, Katarina E
    Nursing staff ratio and skill mix in Swedish emergency departments: A national cross-sectional benchmark study.2021Inngår i: Journal of Nursing Management, ISSN 0966-0429, E-ISSN 1365-2834, Vol. 29, nr 8, s. 2594-2602Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    AIM: To describe ratio and skill mix for nursing staff in Swedish emergency departments over a specific 24-hour period.

    BACKGROUND: The link between number of patients per nursing staff and missed nursing care is well described within the in-hospital setting, showing association with negative outcomes such as increased mortality. Potential association within the emergency department setting is still unexplored.

    METHOD: A national descriptive cross-sectional benchmark study.

    RESULTS: The majority (n=54; 89%) of Swedish emergency departments participated. The patients-per-registered nurse ratio varied between the shifts, from 0.3 patients to 8.8 patients (mean 3.2). The variation of patients per licensed practical nurse varied, from 1.5 to 23.5 patients (mean 5.0). The average skill mix was constant at around 60% registered nurses and 40% licensed practical nurses.

    CONCLUSION: The varying ratios for patient per registered nurse and licensed practical nurse in Swedish emergency departments is noteworthy. Furthermore, the patient flow and nursing staff numbers did not match one another, resulting in higher nursing staff ratios during the evening shift.

    IMPLICATIONS FOR NURSING MANAGEMENT: Findings can be used to improve rosters in relation to crowding, to manage the challenging recruitment and retention situation for nursing staff and to improve patient safety.

    Fulltekst (pdf)
    fulltext
  • 2. Amritzer, Maria
    et al.
    Göransson, Katarina
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska inst, Sweden; Karolinska Univ Hosp, Sweden.
    Berg, Lena M
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska inst, Sweden; Karolinska Univ Hosp, Sweden.
    Nymark, Carolin
    A new perspective of missed nursing care – the emergency department context: a descriptive, cross-sectional study2024Inngår i: Journal of Emergency Nursing, ISSN 0099-1767, E-ISSN 1527-2966, Vol. 50, nr 3, s. 392-402Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction: This descriptive cross-sectional study describes missed nursing care, quality of care, and patient safety rated by nursing staff in emergency departments. Required patient care that is omitted or delayed (missed nursing care) is associated with poorer quality of care and increased risk for adverse events, but studies are scarce in the emergency setting. Methods: Emergency registered nurses and nursing assistants (N=126) at 2 Swedish emergency departments participated in the study. The MISSCARE survey -Swedish version was used for data collection. Results: Emergency nursing staff assessed that nursing care is frequently missed in the emergency department. More than half of the 24 nursing care items were reported as missed by over 50% of the participants, and registered nurses rated most items significantly higher compared to nursing assistants. Half of the nursing staff perceived quality of care to be good, but nearly the same proportion perceived patient safety as poor. Registered nurses viewed both quality and safety worse than nursing assistants. Discussion: The present study found very high levels of missed nursing care in most nursing items. Results indicate that nursing staff in emergency departments need to prioritize between the tasks and that some tasks may not be relevant in the context. The emergency setting focuses primarily on identifying signs of urgency, assessing patients, performing interventions, and diagnostics. However, even items that seemed to be prioritized, such as reassessment of vital signs, had a surprisingly high level of missed nursing care in comparison to in -hospital wards.

    Fulltekst (pdf)
    fulltext
  • 3.
    Berg, Lena M
    Department of Medicine, Solna, Karolinska Institutet.
    Patient safety at emergency departments: challenges with crowding, multitasking and interruptions2018Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    Several challenges with patient safety in the emergency department (ED) context have beenpreviously identified, and some commonly mentioned are crowding, multitasking, andinterruptions. The ED is a complex, high-risk work environment where multiple clinicians(physicians, registered nurses [RNs], and licensed practical nurses [LPNs]) are constantlyworking in parallel work processes, in an often crowded ED, while conducting tasksinvolving cognitively demanding decision-making processes. ED crowding has for the past20 years been identified as a problem internationally, resulting in extended ED length of stay(LOS) and increased morbidity and mortality for patients. ED crowding is also considered tohave negative effects on the clinicians' workload and work satisfaction.

    Both multitasking and interruptions have been identified as risk factors for patient safety byhaving negative effects on a clinician's decision-making processes and thus increasing therisk of forgetting important details and events because of memory overload. However,information has been lacking about what specific work assignments ED clinicians conduct,and thus there is little information about the types of assignments they perform whilemultitasking and being exposed to interruptions. Further, because not all interruptions lead toerrors and because they are not all preventable, a more refined account of interruptions iscalled for. Moreover, it seems that previous studies have not identified which specific factorsinfluence the ED clinicians' perceptions of interruptions. The work environment has beenreferred to as a possible influencing factor, but specific details on the relationship between thework environment and negative effects from interruptions are pending.

    The overall aim of the thesis was to describe ED crowding, and its influence on EDclinicians' work processes (activities, multitasking, and interruptions) and patient outcomes,from a patient safety perspective. The thesis addressed six research questions: 1) How has EDcharacteristics, patient case mix and occurrence of ED crowding changed over time? 2) Whatwork activities are performed by ED clinicians? 3) What kind of multitasking situations areclinicians exposed to during ED work? 4) What kind of interruptions are clinicians exposedto during ED work? 5) How do ED clinicians perceive interruptions? 6) Is there anassociation between ED crowding and mortality for stable patients without the need for acutehospital care upon departure from the ED?

    The data in the thesis were generated from two data collections: 1) registry data containingpatient characteristics and measures of ED crowding (ED occupancy ratio [EDOR], ED LOS,and patient/clinician ratios) extracted from the patients' electronic health records (paper I andIV) and 2) observations and interviews with ED clinicians (physicians, RNs, and LPNs)(paper II and III). Nonparametric statistics were used in paper I and III, quantitative and qualitative content analysis were used in paper II and III, and multivariate logistic regressionanalysis was used in paper IV.

    The main results in the thesis are presented based on Asplin's conceptual model of EDcrowding, from the aspect of input-throughput-output, and how parts of a sub-optimalthroughput influence patient safety through ED clinicians' work processes and patientoutcomes. During 2009 – 2016 there has been a change in patient case mix at the EDs at thestudy hospital, primarily with an increase in unstable patients (input) and a decrease in thenumber of patients admitted to in-hospital care (output). The median for ED LOS over thestudy period increased, and the largest increases occurred among the subgroups of unstablepatients, patients ≥80 years of age, and those admitted to in-hospital care (throughput).Further, an increase in crowding, in terms of median EDOR and median patients per RNratios, was identified, with an increase in EDOR from 0.8 in 2009 to 1.1 in 2016 and anaverage increase of 0.164 patients/RN/year (throughput). The ED clinicians' workassignments consisted of 15 categories of activities, and information exchange was found tobe the most common activity (42.1%). In contrast, the clinicians only spent 9.4% of theiractivities on direct interaction with patients and their families (ED clinicians' workprocesses). The clinicians multitasked during 23% of their total number of performedactivities, and there was an overall interruption rate of 5.1 interruptions per hour. Themajority of the observed multitasking situations and interruptions in the ED clinicians' workoccurred during demanding activities that required focus or concentration (ED clinicians'work processes). Finally, an association was identified between an increase in ED LOS andEDOR and 10-day mortality for stable patients without the need for acute hospital care upondeparture from the ED (patient outcomes).

    This thesis illustrates how a sub-optimal throughput, affected by conditions in both the inputand output components, negatively influence the ED clinicians' work processes as well aspatient outcomes.

    Fulltekst (pdf)
    fulltext
  • 4.
    Berg, Lena M
    et al.
    Karolinska institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska institutet.
    Östergren, Jan
    Discacciati, Andrea
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    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 department2019Inngår i: Annals of Emergency Medicine, ISSN 0196-0644, E-ISSN 1097-6760, Vol. 74, nr 3, s. 345-356Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 5.
    Berg, Lena M
    et al.
    Karolinska University Hospital; Karolinska Institutet.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    An observational study of activities and multitasking performed by clinicians in two Swedish emergency departments2012Inngår i: European journal of emergency medicine, ISSN 0969-9546, E-ISSN 1473-5695, Vol. 19, nr 4, s. 246-251Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectives: To explore the type and frequency of activities and multitasking performed by emergency department clinicians.

    Methods: Eighteen clinicians (licensed practical nurses, registered nurses and medical doctors), six from each occupational group, at two Swedish emergency departments were followed in their clinical work for 2 h each to observe all their activities and multitasking practices. Data were analysed using qualitative and quantitative content analysis.

    Results: Fifteen categories of activities could be identified based on 1882 observed activities during the 36 h of observation. The most common activity was information exchange, which was most often performed face-to-face. This activity represented 42.1% of the total number of observed activities. Information exchange was also the most common activity to be multitasked. Registered nurses performed most activities and their activities were multitasked more than the other clinicians. The nurses’ and doctors’ offices were the most common locations for multitasking in the emergency department.

    Conclusion: This study provides new knowledge regarding the activities conducted by clinicians in the emergency department. The most frequent activity was information exchange, which was the activity most often performed by the clinicians when multitasking occurred. Differences between clinicians were found for activities performed and multitasked, with registered nurses showing the highest frequencies for both.

  • 6.
    Berg, Lena M
    et al.
    Karolinska Institutet; Karolinska University Hospital.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Significant changes in emergency department length of stay and case mix over eight years at a large Swedish University Hospital2019Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 43, s. 50-55Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 7.
    Berg, Lena M
    et al.
    Karolinska University Hospital.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Djärv, Therese
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Reasons for interrupting colleagues during emergency department work: a qualitative study2016Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 29, nr SI, s. 21-26Artikkel i tidsskrift (Fagfellevurdert)
    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.

  • 8.
    Berg, Lena M
    et al.
    Karolinska Institutet; Karolinska University Hospital.
    Källberg, Ann-Sofie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Department of Medicine Solna, Karolinska Institutet; Department of Emergency Medicine, Falun Hospital.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Östergren, Jan
    Djärv, Therese
    Brixey, Juliana J
    Göransson, Katarina
    Karolinska institutet, Stockholm.
    Factors influencing clinicians' perceptions of interruptions as disturbing or non-disturbing: a qualitative study2016Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 27, s. 11-16Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    OBJECTIVE: Emergency departments consist of multiple systems requiring interaction with one another while still being able to operate independently, creating frequent interruptions in the clinical workflow. Most research on interruptions in health care settings has focused on the relationship between interruptions and negative outcomes. However, there are indications that not all interruptions are negatively perceived by those being interrupted. Therefore, this study aimed to explore factors that influence when a clinician perceives interruptions as non-disturbing or disturbing in an emergency department context.

    METHOD: Explorative design based on interviews with 10 physicians and 10 registered nurses at two Swedish emergency departments. Data were analyzed using qualitative content analysis.

    RESULT: Factors influencing whether emergency department clinicians perceived interruptions as non-disturbing or disturbing were identified: clinician's constitution, external factors of influence and the nature of the interrupted task. The clinicians' perceptions were related to a complex of attributes inherent in these three factors at the time of the interruption. Thus, the same type of interruption could be perceived as either non-disturbing or disturbing contingent on the surrounding circumstances in which the event occurred.

    CONCLUSION: Emergency department clinicians' perceptions of interruptions as non-disturbing or disturbing were related to the character of identified influencing factors.

  • 9.
    Berg, Lena M
    et al.
    Karolinska Institutet; Karolinska University Hospital.
    Källberg, Ann-Sofie
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Karolinska Institutet; Department of Emergency Medicine, Falun Hospital.
    Göransson, Katarina
    Department of Medicine Solna, Karolinska Institutet, Solna, Sweden ; Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden.
    Östergren, J
    Department of Medicine Solna, Karolinska Institutet, Solna, Sweden ; Department of Emergency Medicine, Karolinska University Hospital, Solna, Sweden.
    Florin, Jan
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Ehrenberg, Anna
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad.
    Interruptions in emergency department work: an observational and interview study2013Inngår i: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, Vol. 22, nr 8, s. 656-663Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objectiv.e Frequent interruptions are assumed to have a negative effect on healthcare clinicians’ working memory that could result in risk for errors and hence threatening patient safety. The aim of this study was to explore interruptions occurring during common activities of clinicians working in emergency departments.

    Method. Totally 18 clinicians, licensed practical nurses, registered nurses and medical doctors, at two Swedish emergency departments were observed during clinical work for 2 h each. A semistructured interview was conducted directly after the observation to explore their perceptions of interruptions. Data were analysed using non-parametric statistics, and by quantitative and qualitative content analysis.

    Results. The interruption rate was 5.1 interruptions per hour. Most often the clinicians were exposed to interruptions during activities involving information exchange. Calculated as percentages of categorised performed activities, preparation of medication was the most interrupted activity (28.6%). Face-to-face interaction with a colleague was the most common way to be interrupted (51%). Most common places for interruptions to occur were the nurses’ and doctors’ stations (68%). Medical doctors were the profession interrupted most often and were more often recipients of interruptions induced by others than causing self-interruptions. Most (87%) of the interrupted activities were resumed. Clinicians often did not regard interruptions negatively. Negative perceptions were more likely when the interruptions were considered unnecessary or when they disturbed the work processes.

    Conclusions. Clinicians were exposed to interruptions most often during information exchange. Relative to its occurrence, preparation of medication was the most common activity to be interrupted, which might increase risk for errors. Interruptions seemed to be perceived as something negative when related to disturbed work processes.

  • 10.
    Dillner, Pernilla
    et al.
    Karolinska Institutet, Stockholm; Karolinska University Hospital, Stockholm.
    Eggenschwiler, Luisa C
    University of Basel, Basel, Switzerland.
    Rutjes, Anne W S
    University of Modena and Reggio Emilia, Modena, Italy; University of Bern, Bern, Switzerland.
    Berg, Lena M
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Stockholm.
    Musy, Sarah N
    University of Basel, Basel, Switzerland.
    Simon, Michael
    University of Basel, Basel, Switzerland.
    Moffa, Giusi
    University of Basel, Basel, Switzerland.
    Förberg, Ulrika
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Stockholm.
    Unbeck, Maria
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Stockholm.
    Incidence and characteristics of adverse events in paediatric inpatient care: a systematic review and meta-analysis2023Inngår i: BMJ Quality and Safety, ISSN 2044-5415, E-ISSN 2044-5423, nr 3, s. 133-149Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Adverse events (AEs) cause suffering for hospitalised children, a fragile patient group where the delivery of adequate timely care is of great importance.

    OBJECTIVE: To report the incidence and characteristics of AEs, in paediatric inpatient care, as detected with the Global Trigger Tool (GTT), the Trigger Tool (TT) or the Harvard Medical Practice Study (HMPS) method.

    METHOD: MEDLINE, Embase, Web of Science and Google Scholar were searched from inception to June 2021, without language restrictions. Studies using manual record review were included if paediatric data were reported separately. We excluded studies reporting: AEs for a specific disease/diagnosis/treatment/procedure, or deceased patients; study protocols with no AE outcomes; conference abstracts, editorials and systematic reviews; clinical incident reports as the primary data source; and studies focusing on specific AEs only. Methodological risk of bias was assessed using a tool based on the Quality Assessment Tool for Diagnostic Accuracy Studies 2. Primary outcome was the percentage of admissions with ≥1 AEs. All statistical analyses were stratified by record review methodology (GTT/TT or HMPS) and by type of population. Meta-analyses, applying random-effects models, were carried out. The variability of the pooled estimates was characterised by 95% prediction intervals (PIs).

    RESULTS: We included 32 studies from 44 publications, conducted in 15 countries totalling 33 873 paediatric admissions. The total number of AEs identified was 8577. The most common types of AEs were nosocomial infections (range, 6.8%-59.6%) for the general care population and pulmonary-related (10.5%-36.7%) for intensive care. The reported incidence rates were highly heterogeneous. The PIs for the primary outcome were 3.8%-53.8% and 6.9%-91.6% for GTT/TT studies (general and intensive care population). The equivalent PI was 0.3%-33.7% for HMPS studies (general care). The PIs for preventable AEs were 7.4%-96.2% and 4.5%-98.9% for GTT/TT studies (general and intensive care population) and 10.4%-91.8% for HMPS studies (general care). The quality assessment indicated several methodological concerns regarding the included studies.

    CONCLUSION: The reported incidence of AEs is highly variable in paediatric inpatient care research, and it is not possible to estimate a reliable single rate. Poor reporting standards and methodological differences hinder the comparison of study results.

    Fulltekst (pdf)
    fulltext
  • 11.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Falun Hospital and Centre for Clinical Research Dalarna, Falun.
    Berg, Lena M
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Skogli, Sara
    Falun Hospital, Falun.
    Bjurbo, Charlotte
    Uppsala University Hospital, Uppsala.
    Muntlin, Åsa
    Uppsala University Hospital, Uppsala.
    Ehrenberg, Anna
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad.
    Prevalence of frailty and associated factors in older adults seeking care at Swedish emergency departments2023Inngår i: BMC Geriatrics, E-ISSN 1471-2318, Vol. 23, nr 1, artikkel-id 798Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Internationally, prolonged length of stay for older adults in the emergency department (ED) is associated with increased risk of in-hospital adverse events. In Sweden patients 65 years and older account for 35% of emergency visits, and according to consensus from an international expert group, all persons over 70 should be screened for frailty. This is not routinely done in Swedish EDs, and therefore, knowledge about prevalence, characteristics and clinical outcomes associated with frailty is limited.

    AIM: To describe the prevalence of frailty and associated factors in older adults seeking care at Swedish EDs.

    METHODS: The study has a cross-sectional design. Data was collected at three hospital-based EDs, varying in level and size of setting, for one month. Patients age 70 and older presenting at the EDs and agreed to participate were screened for frailty using the FRail Elderly Support researcH group (FRESH) instrument. Data were analysed using descriptive statistics to assess the distribution of patient characteristics and clinical outcomes. Multivariate logistic regression was used to model the association between frailty and demographic characteristics, and Cox regression was used to model the association between frailty and clinical outcomes.

    RESULTS: A total of 3101 patients were eligible for inclusion; of these, 984 (32%) were included and screened for frailty. Of the final sample, 57.3% were assessed as frail. Characteristics significantly associated with frailty were living in a residential care facility, age (> 80 years), being a woman and arriving with emergency medical service (EMS). There was a significant association between frailty and admittance to in-hospital care.

    CONCLUSION: Our study shows a high prevalence of frailty in older people. Factors associated with frailty were living in a residential care facility, age ≥ 80 years, being a woman and arriving with EMS to the ED and being admitted to in-hospital care. Frailty screening should be incorporated in the triage system to identify frail patients who need tailored interventions. More studies using the FRESH instrument are needed to further confirm our findings and to develop the methods for screening for frailty in the ED.

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    fulltext
  • 12.
    Källberg, Ann-Sofie
    et al.
    Högskolan Dalarna, Akademin Utbildning, hälsa och samhälle, Omvårdnad. Falun Hospital.
    Brixey, J. J.
    Johnson, K. D.
    Berg, Lena M
    Karolinska University Hospital.
    Disturbance during emergency department work – A concept analysis2020Inngår i: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 53, artikkel-id 100853Artikkel i tidsskrift (Fagfellevurdert)
  • 13.
    Lundin, Andrea
    et al.
    Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Akram, Shahzad K
    Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Berg, Lena M
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Stockholm.
    Göransson, Katarina E
    Högskolan Dalarna, Institutionen för hälsa och välfärd, Omvårdnad. Karolinska Institutet, Stockholm.
    Enocson, Anders
    Karolinska University Hospital, Stockholm; Karolinska Institutet, Stockholm.
    Thoracic injuries in trauma patients: epidemiology and its influence on mortality2022Inngår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, E-ISSN 1757-7241, Vol. 30, nr 1, artikkel-id 69Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Thoracic injuries are common among trauma patients. Studies on trauma patients with thoracic injuries have reported considerable differences in morbidity and mortality, and there is limited research on comparison between trauma patients with and without thoracic injuries, particularly in the Scandinavian population. Thoracic injuries in trauma patients should be identified early and need special attention since the differences in injury patterns among patient population are important as they entail different treatment regimens and influence patient outcomes. The aim of the study was to describe the epidemiology of trauma patients with and without thoracic injuries and its influence on 30-day mortality.

    METHODS: Patients were identified through the Karolinska Trauma Register. The Abbreviated Injury Scale (AIS) system was used to find patients with thoracic injuries. Logistic regression analysis was performed to evaluate factors [age, gender, ASA class, GCS (Glasgow Coma Scale), NISS (New Injury Severity Score) and thoracic injury] associated with 30-day mortality.

    RESULTS: A total of 2397 patients were included. Of those, 768 patients (32%) had a thoracic injury. The mean (± SD, range) age of all patients (n = 2397) was 46 (20, 18-98) years, and the majority (n = 1709, 71%) of the patients were males. There was a greater proportion of patients with rib fractures among older (≥ 60 years) patients, whereas younger patients had a higher proportion of injuries to the internal thoracic organs. The 30-day mortality was 11% (n = 87) in patients with thoracic injury and 4.3% (n = 71) in patients without. After multivariable adjustment, a thoracic injury was found to be associated with an increased risk of 30-day mortality (OR 1.9, 95% CI 1.3-3.0); as was age ≥ 60 years (OR 3.7, 95% CI 2.3-6.0), ASA class 3-4 (OR 2.3, 95% CI 1.4-3.6), GCS 1-8 (OR 21, 95% CI 13-33) and NISS > 15 (OR 4.2, 2.4-7.3).

    CONCLUSION: Thoracic injury was an independent predictor of 30-day mortality after adjustment for relevant key variables. We also found a difference in injury patterns with older patients having a higher proportion of rib fractures, whilst younger patients suffered more internal thoracic organ injuries.

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    fulltext
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