Syfte: Att kartlägga triagekunskap hos kliniskt verksam ambulanspersonal i en masskadesituation med patientfall från MACSIM. Metod: Studien är en kvantitativtvärsnittsstudie som baseras på en webenkät med 84 respondenter som arbetar inom ambulansverksamheten. Enkäten innehöll slutna bakgrundsfrågor och ett kunskapstest med 30 patientfall som bygger på simuleringsverktyget MACSIM. All data bearbetades med analytiskoch deskriptiv statistik. Resultat: Studien resulterade i totalt 2520 triageringar, inklusive 924 triageringar av barn. Resultatet visar total korrekt triage (66,8 %), undertriage (17,9 %) och övertriage (15,2 %) samt triage av barn som visar korrekt triage (72,7 %), undertriage (8,4 %) och övertriage (18,8 %). Studien visar signifikanta och icke signifikanta skillnader i ovanstående triageresultat beroende på bakgrundsfaktorer. Konklusion: Det framkommertydligt i denna studie att ambulanspersonal är i behov av mer utbildning i hur man triagerar enligt sållningstriage vid en masskadesituation. Sållningstriage är tänkt att vara ett enkelt tillvägagångssätt under det första triaget vid en masskadesituation. Trots detta var det bara ett fåtal av deltagarna som hade en acceptabel nivå av såväl korrekt triage som undertriage.Däremot visar det totala resultatet en acceptabel nivå av övertriage. / Aim: The aim of this study is to identify triage knowledge of clinically active ambulance personnel in a mass casualty incident (MCI) with patient cases from MACSIM. Method: The study is a quantitative, cross-sectional study based on a digital survey with 84 respondents working in the prehospital organization. The survey included closed background questions and a knowledge test with 30 patient cases based on the simulation tool, MACSIM. All data were processed with analytical and descriptive statistics. Results: The study resulted in total of 2520 triages, including 924 triages of children. Results showed a total correct triage (66,8 %), undertriage (17,9 %) and overtriage (15,2 %) and triage of children showing correct triage (72.7%), undertriage (8.4%) and overtriage (18.8%). The study shows significant and nonsignificant differences in the above triage results depending on the background factors.Conclusion: It stands clear in this study that ambulance personnel need more education in how to triage according to MCI triage. MCI triage is supposed to be an easy approach during the first triage in an MCI. Even so, only a small number of the participants had an acceptable level of correct triage as well as undertriage. However, the overall result showed an acceptable level of overtriage.

The increasing global deficit of healthcare resources makes efficiency improvements in the healthcare industry a complete necessity to assure safe and available healthcare for everyone. Digitalization is expected to play a fundamental role in this transition and digital primary healthcare providers have in recent years developed into a substantial part of the Swedishprimary care sector. Several of those have built solutions for automated triage, where the role of a triage officer in traditional primary care is replaced by an automated process, in which an triage algorithm directly refers the patient to the appropriate level of care. Despite the rise of digital healthcare providers and automated primary care triage systems in particular, research on the implications of automating the triage process in primary healthcare is scarce. This study aims to assess the potential of using MCDM models for automated triage in digital primary care, by conducting a single case study at one of the leading digital healthcare providers. The study is separated into two phases. In phase one, interviews are conducted to qualitatively determine what set of factors to include in an automated MCDM triage model.In phase two, the resulting model is simulated to evaluate the performance compared to the traditional triage model in which all patient journeys start with an initial nurse meeting. The study shows that an automated MCDM triage model can improve cost efficiency in terms of clinician salary costs and productivity in terms of fewer consultations per patient, compared to the traditional triage model. However, the traditional triage model is shown to be more efficient in terms of only utilizing doctor resources for patients in absolute need of doctor care. / Det ökande underskottet av sjukvårdsresurser gör effektivitetsförbättringar i sjukvårdsbranschen nödvändigt för att säkerställa säker och tillgänglig sjukvård för alla. Digitalisering förväntas fylla en fundamental roll i denna transformation och digitala vårdgivare i primärvården har under de senaste åren växt till en betydande del av den svenska primärvårdssektorn. Flertalet av dessa har byggt lösningar för automatiserat triage, där triagefunktionärens roll ersätts av en automatiserad process där en triagealgoritm direkt hänvisar patienten till den lämpliga vårdnivån. Trots tillväxten av digitala vårdgivare i primärvården och deras automatiserade triagesystem i primärvården är forskning kring effekterna av att automatisera triageprocessen i primärvården begränsad. Denna studie strävar efter att utvärdera potentialen i att använda MCDM-modeller för automatiserat triage i den digitala primärvården genom en casestudie på en av de ledande digitala vårdgivarna i primärvården. Studien är uppdelad i två delar. I del ett genomförs intervjuer för att kvalitativt fastställa vilka faktorer som bör inkluderas i en automatiserad MCDM-modell för triage. I del två simuleras den resulterande MCDM-modellen för att utvärdera dess resultat jämfört med den traditionella triagemodellen i vilken alla patienter har ett inledande möte med en sjuksköterska. Studien visar att en automatiserad MCDM-modell för triage kan förbättra kostnadseffektiviteten i termer av lönekostnader och produktivitet i termer av färre konsultationer per patient, jämfört med den traditionella triagemodellen. Däremot visar den traditionella triagemodellen högre effektivitet i termer av att enbart utnyttja läkarresurser för patienter i absolut behov av läkarvård.

Die Unzufriedenheit der Patient:innen steht oft in Kohärenz mit überfüllten Notaufnahmen. Dabei sind besonders die Überschreitung der Ressourcen und Verzögerungen bei der Wartezeit zusammenhängend zu betrachten. In den 1990er Jahren wurde nach einem System zur Verbesserung des Zeitmanagements gesucht. Dies führte zur Methode der Triage. Trotz der Einführung der Triage ist die Patientenunzufriedenheit immer noch ein häufiges Gesprächsthema, wenn es um die Notaufnahme geht. Unter Berücksichtigung des architekturpsychologischen Aspekts stellt sich die Frage: „Wie kann die Raumgestaltung des Wartebereiches architektonisch an das individuelle Empfinden von Patient:innen bei einer Triage angepasst werden?“. Um diese Frage zu beantworten, wurde eine Umfrage mit verschiedenen Sichtweisen von Personen durchgeführt. Betrachtet wurden einerseits Patient:innen, sowie Begleitpersonen und andererseits Personen, die noch gar nicht in der Notaufnahme waren. Anhand der Umfrageergebnisse wurden Hauptkriterien ermittelt, die sich auf die Empfindungen der Patient:innen und Begleitpersonen beziehen. Resümierend haben sich zum einen die Privatsphäre, sowie Ausruhmöglichkeiten und zum anderen Gesichtspunkte wie Ablenkung und eine gute Atmosphäre als Hauptkriterien eines Warteraumes ergeben. Aus den aufgestellten Kriterien wurden verschiedene, raumgestaltende Elemente entwickelt, die sich den Bedürfnissen der wartenden Patient:innen und deren Begleitpersonen anpassen. Sie dienen als Gestaltungsempfehlungen.

Personalen som triagerar och placerar patienter på Södersjukhusets akutmottagning använder det digitala patientjournalsystemet TakeCare. TakeCare är ett hyllat journalsystem som används i hela Region Stockholm sedan 2013. Sjuksköterskorna som använder programmet upplever dock att det kan förbättras, särskilt när det gäller användargränssnittet för placeringen av nya patienter. Det nuvarande programmet saknar en tydlig överblick över akutmottagningens olika moduler och vårdlag, vilket försvårar sjuksköterskornas beslut om patientplacering. De behöver gå igenom varje modul för sig för att få en uppfattning om vårdbelastningen i varje modul. En prototyp för en beslutsstödjande webbapplikation med översiktlig information om belastning på varje modul skulle potentiellt kunna integreras i TakeCare och underlätta sjuksköterskornas process för placering av patienter. I denna studie skapades en webbapplikation som kan utvecklas vidare och eventuellt användas av sjukvårdspersonalen. Denna rapport bevisar att det finns förbättringspotential hos det nuvarande patientjournalsystemet och att ett beslutsstöd för placering av patienter skulle underlätta processen och förbättra vårdflödet. / The triage nurses that are responsible for the placement of patients at Södersjukhuset’s emergency department in Stockholm, Sweden, use the digital medical record system TakeCare. TakeCare is a renowned record system that has been used in Region Stockholm since 2013. However, the nurses using the system experience some difficulty, especially when it comes to the user interface when placing new patients. The current system lacks a clear overview of the emergency departments' many modules and healthcare teams, which makes it difficult to make decisions regarding the placement of incoming patients. The nurses are therefore forced to go through each module one by one to see the current strain in each team. A prototype for a decision-supporting web application with a clear overview of each module could potentially be integrated into the current medical record system and thus facilitate an easier placement process. A web application was made in this study and can eventually be used by the health care staff after further development. This report proves that there is potential for improvement for the current system and that a decision-making tool would improve the flow in the ED.

There is a paucity of literature evaluating mass casualty systems and no clear 'gold standard' for measuring the efficacy of information decision support systems or triage systems that can be used in mass casualty events. The purpose of this research was the preliminary validation of a comprehensive conceptual model for a mass casualty continuum of care. This research examined key relationships among entities/factors needed to provide real-time visibility of data that track patients, personnel, resources and potential hazards that influence outcomes of care during mass casualty events.A modified Delphi technique was used to validate the proposed model using a panel of experts. The four research questions measured the extent to which experts agreed that the: 1) ten constructs represent appropriate predictors of outcomes of care during mass casualty events; 2) proposed relationships among the constructs provide valid representations of mass casualty triage; 3) proposed indicators for each construct represent appropriate measurements for the constructs; and 4) the proposed model is seen as useful to the further study of information and technology requirements during mass casualty events. The usefulness of the online Delphi process was also evaluated.A purposeful sample of 18 experts who work in the field of emergency preparedness/response was selected from across the United States. Computer, Internet and email applications were used to facilitate a modified Delphi technique through which experts provided initial validation for the proposed conceptual model. Two rounds of the Delphi process were needed to satisfy the criteria for consensus and/or stability related to the constructs, relationships and indicators in the model. Experts viewed the proposed model as relatively useful (Mean = 5.3 on a 7-point scale). Experts rated the online Delphi process favorably.Constructs, relationships and indicators presented in this model are viewed as preliminary. Future research is needed to develop the tools to measure the constructs and then test the model as a framework for studying effects and outcomes of mass casualty events. This study provides a foundation for understanding the complex context in which mass casualty events take place and the factors that influence outcomes of care.

Telephone nursing (TpN) care is delivered in a wide range of settings and provides a variety of services to individuals and populations across the age span. Although a viable specialty practice, there is little evidence regarding how the process of care delivery contributes to successful outcomes. To study the effects of TpN care, and to develop appropriate clinical and education interventions, a solid understanding of the process is needed. This study utilized grounded theory method to identify and describe the core concepts of the TpN process, the relationships among these concepts, and the factors influencing the process. Study findings were validated through peer and participant review. Based on interviews with ten telephone nurses from four sites, the following components were identified and organized into a conceptual model of the TpN process. The process generally proceeds through three phases, gathering information to cognitive processing to output. Throughout these phases, the nurse engages in a goal oriented parallel process focusing on both explicit (e.g., verbal, physical) and implicit (non-verbal, contextual) dimensions. Inherent to this parallel process is a two-way interpreting process in which information from the caller is translated into health care language for processing and then health care information is translated back into the language of the caller to identify and meet their needs. Factors influencing the process include prioritization and the level of complexity of the call, resources of the nurse and the organization, and the nurse's desire for validation of the service and the appropriateness of the output. The model highlights the need for research further delineating how implicit information is gathered and processed and how it influences output. Research is also needed on the value of implicit output and on the effects of feedback regarding output on nurse performance and satisfaction. The model suggests that more nursing education should be focused on the sub-processes within the three phases, the interpreting process, and implicit aspects of the process. Finally, the model suggests that formal feedback regarding the quality of call output should be provided and the value of implicit nursing output should be recognized.

This study measured the culture of Barren County High School using the School Culture Triage Survey. The survey was administered to the teachers and administrators separately to assess the difference of the perception of the school culture within that school. The research suggests that improving a schools culture will increase teacher moral, teacher and administrator cohesiveness, and increase students’ achievement. The results of this research show that the overall school culture is perceived very similarly between the two subgroups (teachers and leadership) but there are areas of the schools culture that are perceived differently, and if improved, can lead to significant gains for teachers and student learning and achievement.

No description available.

Omvårdnad på distans är ett växande område i västvärlden. Sjukvårdsrådgivning via telefon sysselsätter allt fler sjuksköterskor. Arbetet innebär att bedöma, hänvisa och ge råd i till inringare i hälso- och sjukvårdsfrågor. Syftet med studien var att undersöka sjuksköterskans erfarenhet av att arbeta med sjukvårdsrådgivning via telefon. Metoden var en litteraturstudie. Med inspiration av innehållsanalys bearbetades två kvantitativa och nio kvalitativa studier. Resultatet utmynnade i tre kategorier: Samtal och inringare, Omvårdnad och yrkesroll, Organisation och teknik. Kategorierna representerar olika delar av arbetsmiljön och arbetsvillkoren som en telefonsjuksköterska verkar inom. Telefonsjuksköterskorna upplevde att de trots distansen till inringaren arbetade med omvårdnad, detta genom sin röst och kommunikation. Avsaknad av synintryck försvårade samtalen, både i bedömningen och etiskt då telefonsjuksköterskan aldrig kunde vara säker på inringarens identitet. Resultatet visar på behov av ytterligare utbildning inför arbetet som telefonsjuksköterska. Forskning behövs kring användandet av det datoriserade beslutstödet samt innehållet, för att telefonsjuksköterskan ska kunna göra adekvata bedömningar och rätt hänvisningar. Kommunikation är det främsta verktyget i arbetet med sjukvårdsrådgivning via telefon, fortlöpande utbildning som fokuserar på detta bör erbjudas till telefonsjuksköterskor. / Telenursing is a growing concept within the western society. More nurses are employed by medical care hotlines. It involves estimating medical situations, referring, and giving counseling advice. The purpose of this study was to investigate nurses experiences with executing their profession over the phone. The method was a literature study, with inspiration drawn from content analysis. Two quantitative and nine qualitative studies were discussed and resulted in three categories: Calls and callers, Nursing and profession, Organizational structure and technique. These categories represent the various parts of the working environment and conditions that a telenurse operates within. Despite the physical distance to the caller, the telenurses still felt they were nursing, using their voices and communication. Lack of visual impressions can be a cause of obstruction for telenurses in judging the callers condition, but also in an ethical sense since the nurse could never be confident in the callers identity. The result of this study identifies a need for further education as a preparation to becoming a telenurse.Research is needed regarding the usage of computerized decision aid, to make adequatejudgements and thus giving the correct referrals. Communications is the key tool fortelenursing, and further education that focuses on improving this should be given to employees within the field.

Emergency department (ED) overcrowding has been a common complaint in Emergency Medicine in Canada for many years. Its adverse effects of prolonged waiting times cause patient dissatisfaction and unsafety. Previous studies indicate that adding a physician in triage (PIT) can increase accuracy and efficiency in the initial process of patient evaluation. However, the scientific evidence of the PIT impact on ED is far away from sufficient before its widespread implementation. This research is to search solutions using PIT to identify areas of improvement for the ED patient flow, based upon a validated discrete-event simulation (DES) model. As an efficient decision-making tool, the DES model also helps to develop an understanding of the current ED performance and quantitatively test various design alternatives for ED operations. / February 2017