<p>The pressure is getting tougher on Accident and Emergency departments. Therefore it is crucial to study how the patient’s perceive their visit to the Emergency department. Knowledge about this enables improvement of routines, patient participation and patient safety. The purpose of the study was to investigate patient’s experiences of their visit at the Emergency department.</p><p>A descriptive design was used. Patients (n=91) who visited the Emergency department at Uppsala University Hospital during two weeks in October 2009, answered a questionnaire. The questionnaire consisted of 13 questions about the visit, waiting time and information.</p><p>The result showed that most of the patients found that the waiting time was acceptable and they perceived that the staff was competent and professional. On the other hand most patients perceived that they did not receive enough information of the prioritization of the patients in the Emergency department and information about expected waiting time.</p><p>The study result shows that one part of the patient didn´t get information about expecting waiting time and the order of priority and the conclusion was that the study shows that the majority of the patients perceived their Emergency department visit as positive.</p>

The pressure is getting tougher on Accident and Emergency departments. Therefore it is crucial to study how the patient’s perceive their visit to the Emergency department. Knowledge about this enables improvement of routines, patient participation and patient safety. The purpose of the study was to investigate patient’s experiences of their visit at the Emergency department. A descriptive design was used. Patients (n=91) who visited the Emergency department at Uppsala University Hospital during two weeks in October 2009, answered a questionnaire. The questionnaire consisted of 13 questions about the visit, waiting time and information. The result showed that most of the patients found that the waiting time was acceptable and they perceived that the staff was competent and professional. On the other hand most patients perceived that they did not receive enough information of the prioritization of the patients in the Emergency department and information about expected waiting time. The study result shows that one part of the patient didn´t get information about expecting waiting time and the order of priority and the conclusion was that the study shows that the majority of the patients perceived their Emergency department visit as positive.

Syfte: Att beskriva faktorer av betydelse för patienttillfredsställelse på akutmottagningen.Metod: En litteraturstudie med beskrivande design. Data baserades på 13 artiklar sökta i databasen PubMed.Resultat: Totalt identifierades sju faktorer av betydelse för patienttillfredsställelsen av vården på akutmottagningen. Faktorerna var patientens bakgrund, vårdpersonalens bemötande, information, kommunikation, triageprocessen, väntetid och miljö. Resultatet visade att den viktigaste faktorn som hade betydelse för patientens tillfredställelse på akutmottagningen var väntetiden, ovissheten kring denna och triageprocessens påverkan.Slutsats: Faktorerna visade sig vara viktiga var för sig och ännu viktigare i kombination med varandra. Om patienterna var missnöjda med en faktor påverkade det ofta tillfredställelsen av de andra faktorerna under besöket på akutmottagningen. Väntetiden tyder sig vara den mest betydande faktorn för patienttillfredsställelse i kombination med att triagesystemet påverkade hur länge patienterna faktiskt väntade på akutmottagningen. Forskning finns om vilka faktorer som var betydande för patienterna på akutmottagningen, ändå var patienterna fortsatt otillfredsställda och ovetande på akutmottagningen. Ytterligare forskning behövs kring samband mellan faktorer som är betydande för patienttillfredsställelsen på akutmottagningen och specifikt triagesystemets betydelse för väntetider och patienttillfredsställelse. Även forskning om triagesystemet är ett fungerande system, då samband visats med väntetider. / Aim: To describe the factors of patient satisfaction in the emergency department. Method: A literature review with descriptive design. The data was based on 13 articles searched in the PubMed database.Result: In total, seven factors of patient satisfaction of care were identified in the emergency department. The factors were the patient's background, health professional response, information, communication, the triage process, waiting time and the environment. The result showed that the main factor that had an impact on patient satisfaction in the emergency department was waiting time, the uncertainty surrounding this and the impact of the triageprocess. Conclusion: The factors shown to be important in itself, and more importantly, in combination with each other. If patients were dissatisfied with one factor it often affected the satisfaction of the other factors during the visit to the emergency department. The waiting time suggest being the most significant factor for patient satisfaction and the triage system affected how long the patients actually waited in the emergency department. Research exists on what factors that are significant for patients in the emergency department. Yet patients continued to be unsatisfied and unaware in the emergency department. Further research is needed about the relationship between the factors that are important for patient satisfaction in the emergency department and specific the triage system's impact on waiting times and patient satisfaction. Also research on the triage system as a functioning system, as association showed to waiting times.

Beslutsprocessen vid triage är komplex och triageprocessen bör utföras noggrant. Vid akuta situationer måste snabba beslut tas, oftast med lite information. Det ska under kort tid samlas in data genom observation, frågor och kontroll av vitalparametrar. Syftet med studien var att belysa faktorer som påverkar sjuksköterskans triagering av barn på akutmottagning. Studien genomfördes som en litteraturstudie där 13 vetenskapliga artiklar analyserades. I resultatet framkom fyra kategorier: kompetens och erfarenhet hos sjuksköterskan vid triagering av barn, faktorer relaterat till barn och vitalparametrar vid triagering av barn, sjusköterskans kommunikation med barn och närstående vid triagering och beslutsstöd i form av triagesystem. Kontrollen av vitalparametrarna är en grund i triagering men den kan utgöra en otillförlitlig bas för en korrekt triagebedömning. Stor utmaning är i att identifiera avvikande vitalparametrar och ha kunskap om utveckling och beteende relaterat till barnets utvecklingsnivå. Triagering av barn ställer speciella krav på triagesjuksköterskan och på de triagesystem som används. Genom att tydliggöra sjuksköterskans kunskap och skapa en förståelse kring triagering av barn uppmärksammas barnets behov. Vårdverksamheten behöver satsa på utbildning och utveckling av ett triagesystem för barn för att öka patientsäkerheten. Ytterligare forskning behövs om vilka faktorer som påverkar sjuksköterskan i bedömningen av det sjuka barnet. / To make a triage decision is a complex process that should be conducted carefully. In emergency situations quick decisions must be made, often with little information about the patient. In a short time information about the patient should be collected through observation, questioning and monitoring of vital parameters. The purpose of this study was to elucidate factors that influence the nurse in the triage process of children in the emergency department. The study was conducted as a literature study in which 13 scientific articles were analyzed. The result revealed four categories: skills and experience of the nurse in triaging children, factors related to children and vital parameters in triaging children, the communication between the nurse and the child and relatives during triaging, decision support in form of a triage system. Monitoring of vital parameters sets the ground to the triage decision but it can be an unreliable basis for an accurate triage assessment. A major challenge is to identify abnormal vital parameters and to understand the development and behavior related to the child’s level of development. Triaging of children puts special demands on the triage nurse and the triage system that is used. By elucidating the nurse’s knowledge and by creating an understanding of triaging of children, more attention is drawn to the needs of the child. Health care institutions need to invest in education and development of triage systems for children to improve patient safety. Further research is needed on which factors that affect the nurse in the assessment of the sick child.

Background: Incoming medical alarm is a common routine for emergency nurses. Working in these situations may represent a major burden on the individual nurse. Purpose: To investigate emergency room nurses' experiences in receiving medical alerts focused on education, safety, security, skills and experience, and andherence to guidelines. The purpose was also to investigate whether there were any differences in action between the emergency room nurses who had worked longer or shorter period than two years with this. Method: The design was quantitative, comparative and descriptive. Surveys were distributed to 30 nurses who worked in the emergency room at a Swedish hospital. The questionnaires were answered by 20 nurses these were divided into two groups based on their experience, the groups were compered whether there were any differences in action between the emergency room nurses who had worked longer or shorter period than two years in the emergency room. Results : Emergency Room Introduction, 70% had an experienced colleague. Securities in emergency situation were always experienced by 20% of the nurses while 65%of them often felt secure. Safeties were experienced by 60%. Few nurses reported that they experienced stress and time pressure. Half of the group always thought that their experience and skills were a applied in alarm situations. 50% did know the accepted guidelines. Decision aids was not used to any great extent. There was no difference between groups in the conduct of the emergency situation. Conclusion: Emergency Room introduction and decision support needs to be improved. The majority of the nurses felt safe and secure in emergency situation.

Hintergrund: Triage und Ersteinschätzung von Patienten in der Krankenhaus-Notaufnahme als Instrument der Prozeßgestaltung. Übersicht: In den vergangenen Jahren zeigte sich deutschlandweit ein Trend. Die Versorgung von Patienten in den Notaufnahmen der Krankenhäuser erlangt eine immer größere Bedeutung. Bedeutendste Ressource in der Notaufnahme ist die ärztliche Arbeit. Diagnosestellung und Festlegung der Therapie sind die wesentlichen Leistungen. Es ist entscheidend, die Prozessqualität am Punkt des Erstkontaktes des Notfallpatienten mit dem Krankenhaus zu verbessern. Das Universitätsklinikum Dresden eröffnete 2012 mit der Konservativen Notaufnahme (KNA-S1) eine neue, interdisziplinäre Funktionsstelle. Organisatorische Intervention war die Entlastung und Steuerung der Ressource „Arbeitszeit Arzt“. Es wurde das Manchester Triage System als Steuerungsinstrument implementiert mit den Zielen: • Optimale Nutzung der Infrastruktur • Neu definierter und verbesserter Ablauf der Integration von Notfallpatienten in den Behandlungsprozeß und den Geschäftsprozeß des UKD. • Entwicklung von Handlungsempfehlungen für das Pflegepersonal für Maßnahmen am Patienten vor Arztkontakt Schlussfolgerungen: Die strukturierte Ersteinschätzung von Patienten ist ein zielführendes Instrument, um den organisatorischen Reifegrad des Workflows in der Notaufnahme zu erhöhen. Auf dieser Grundlage entwickelte Handlungsempfehlungen für das Pflegepersonal schaffen für Patienten, Ärzte und Pflegepersonal ein optimiertes, Risiko-reduziertes Umfeld. / Background: Triage and initial assessment of patients in Emergency Departments as organizational tool for process improvement. Summary: A trend occurred throughout Germany during the past years. Hospital Emergency Departments achieve increasing importance in patient care. Crucial resource in the ED is physician´s work and authority for diagnosis and therapy. It is important to improve process quality at the point of emergency patient´s first contact to hospital. In 2012 University Hospital Dresden established a new interdisciplinary infrastructure in emergency care for medical and neurological patients (KNA-S1). Organizational intervention has been to relieve and control workload and schedule of the physicians. The Manchester Triage System was implemented as instrument for process control aiming: • Optimized utilization of resources • improved workflow of how emergency patients are introduced into treatment and hospital workflow • Development of guidelines for nursing staff to accomplish appropriate procedures on patients before seeing the physician first Conclusion: Operating an initial assessment on emergency patients leads to improvement of quality and proficiency throughout the operating procedures of an Emergency Department. Guidelines for nursing staff on this foundation will create an optimized and risk reduced environment for patients, physicians and all medical professionals in the ED.

Bakgrund: På akutmottagningen använder sjuksköterskor triageriktlinjer för att bedöma hur akut patienters sjukdomstillstånd är. Triage är en komplex uppgift som kräver kritiskt tänkande och medicinsk kunskap. Sjuksköterskor har en viktig roll i patienters upplevelse av att söka vård på akutmottagningen. Syfte: Syftet var att sammanställa och belysa forskning som beskriver sjuksköterskors triagearbete på akutmottagningen. Metod: Vald metod var litteraturöversikt med både kvalitativa- och kvantitativa artiklar. Datamaterialet bestod av nio kvalitativa och tre kvantitativa artiklar Resultat: Vid analysen identifierades fyra teman. Dessa var Sjuksköterskors sätt att arbeta med triage, Sjuksköterskors kollegor i triagearbetet, Sjuksköterskors arbetsmiljö i triagearbetet samt Sjuksköterskors förhållningssätt till patienter i triagearbetet. Konklusioner: Tillsammans kan sjuksköterskor stärka professionen och blir säkrare i sina triagebeslut. Sjuksköterskor behöver ha en god självkännedom. Sjuksköterskor har behov av att organisationen ger rätt förutsättningar för att god vård ska kunna bedrivas. Resultatet tyder på att mer forskning inom ämnet behövs för att utveckla sjuksköterskors roll i triagearbetet på akutmottagningen. / Background: Nurses use triage guidelines to sort patients who seek care in the emergency department. It is a complex situation which demands critical thinking and medical knowledge. Nurses play an important role in patients’ experience of seeking care in the emergency department. Aim: To gather and identify research which describes nurses’ triage work in the emergency department. Method: The chosen method was a literature review. The data consisted of nine qualitative and three quantitative studies. Results: Four themes were identified through the analysis. These where Nurses’ way of working with triage, Nurses’ work related relationships in their triage work, Nurses’ work environment in their triage work and Nurses’ attitudes to patients in their triage work. Conclusions: If nurses work together they can strengthen the profession and be more confident in their triage decisions. Nurses need to have good self-knowledge. If good health care is to be conducted, nurses need the administration to provide the right conditions. The study suggest that more research is needed, which can develop nurses’ role in the triage work in the emergency department.

Antalet barn som anhöriga till patienter som erhåller vård och transport till sjukhus är okänt. Barn under 18 år kan ibland vara närvarande på hämtplatsen när ambulanssjukvården hämtar barnets anhörig. Hur många barn som anhöriga som är närvarande är okänt inom ett västsvenskt ambulansområde. Triagesystemet RETTS används vid triagering och bedömning av anhöriga till barnen. Syftet med studien är att kartlägga hur många barn som är närvarande då deras anhöriga ges vård, behandling och transport till en vårdinrättning vid prioritet 1 och 2 larm. En enkät skapades för att samla in data till studien. Barn som anhöriga finns även inom ambulanssjukvård. I denna studie identifierades 155 barn vid 95 ambulansuppdrag. Barn som anhörig ses till både vuxna, vanligen en förälder, som till barn. Ett flertal barn som anhöriga är närvarande när en anhörig påvisar svåra, kanske livshotande symptom. Sammanfattningsvis visade studien att stödet till barn och kunskapen om stöd fanns inte inom det ambulansområde där studien är genomförd. / Children as next of kin to patients who are treated by an ambulance nurse in Swedish ambulance service in unknown. Children under 18 years of age may sometimes be present when their parent or other next of kin, has to call the ambulance service due to illness or accident. How many children who experience their next of kin transported to hospital within a Western Swedish ambulance service district is unknown. The purpose of this survey is to identify how many children actually are present when their next of kin may need care and treatment from an ambulance service. Purpose: Survey how many children are present when an ambulance nurse cares and treats a next of kin due to illness or an accident, prioritized as priority 1 or 2. Method: a survey conducted by ambulance nurses in a western Swedish ambulance service. The survey has a quantitative design. Children as next of kin are present within a Swedish ambulance service district, in this survey 155 children was identified in a total of 95 ambulance missions. Children as next of kin are seen as adults, in most cases, a parent as well as children usually a sibling. Many children are present when their relative shows sign and symptoms of severe illness.

ABSTRACT Context: Requirements triage is a crucial activity in requirements engineering process for market-driven products. Triage deals with selection of appropriate requirements from large number of requirements for particular release plan. If triage is not performed initially, selection and management of a large number of requirements would be difficult in requirements engineering process. In market-driven product development triage is followed by estimation and prioritization of requirements to be selected for a particular release plan, also termed as requirements selection. Product development is done based on the set of requirements selected in requirements selection process. Objectives: The objective of the thesis is to find whether there is a need to improve existing requirements triage process or not, identify the challenges and shortcomings of the existing requirements triage and selection solutions and suggest improvements to address identified challenges and shortcomings. Methods: In order to identify existing requirements triage and selection solutions (method, model, tool, technique, process, and others), challenges addressed by existing requirements triage and selection solutions, and the shortcomings faced while implementing them, a systematic literature review has been done. A list of challenges and shortcomings, identified through the analysis of systematic literature review results, was used as an input to industrial survey to confirm most applicable (relevant) challenges and shortcomings and to identify possibilities to address those challenges and shortcomings. Results: A process framework for requirements triage has been proposed to address the challenges faced by practitioners during triage. The steps and solutions proposed within the framework also enable to alleviate the shortcomings of the existing requirements triage solutions. Conclusions: The results of the survey have been analyzed from different perspectives: size of organization, number of requirements handled per month and experience of professional doing triage. Therefore, the proposed process framework is usable and useful for both small-scale and large-scale organizations. The initial effort required to put framework process steps in place would be high, however, later the effort will reduce not only for requirements triage but also for later phases in requirements engineering. As a spin off effect the quality of triage decision is increased.

Bakgrund. Primärvården expanderar globalt och genomgår en förändring. Tillgänglighet prioriteras vilket har lett till en ökning av triage via telefonrådgivning och drop-in mottagningar.  Syftet med litteraturstudien var att undersöka för- och nackdelar med triage i primärvården relaterat till patientsäkerhet. Metod. En integrativ litteraturstudie med induktiv ansats. Mixad metod med både kvalitativa och kvantitativa artiklar användes och konvergent parallell design användes för att analysera artiklarna. Huvudresultat. Triage i primärvården bedömdes vara patientsäkert. Sjuksköterskor hade en god kommunikationsförmåga som bidrog till ökad patientsäkerhet. Däremot identifierades flertalet faktorer som riskerade att hota patientsäkerheten. Nackdelar vid triage via telefonrådgivning som uppmärksammades var bland annat beslutsstödsystemets brister och bristande kommunikationskunskaper hos sjuksköterskorna. Drop in-mottagningar behövde utvecklas men ansågs dock generellt främja patientsäkerheten. Vidare utbildning inom triage och kommunikation önskades för att säkerställa patientsäkerheten. Slutsats. Triage i primärvården via telefonrådgivning är fördelaktigt för patientsäkerheten. Litteraturstudiens resultat antyder även att triage vid drop in-mottagningar är fördelaktigt för patientsäkerheten, men ytterligare studier inom området krävs för att kunna undersöka om detta resultat reflekterar verkligheten. Sjuksköterskors kommunikationsförmåga kan utgöra både för- och nackdelar med triage i primärvården i förhållande till för patientsäkerheten, beroende på om kommunikationsförmågan är god eller bristande. Ett antal faktorer identifieras som riskerar att hota patientsäkerheten. / Background. Primary care is expanding globally and undergoing change. Accessibility is a priority, which has led to an increase in triage via telephone counseling and walk-in centres.  The purpose of this literature review was to examine advantages and disadvantages with triage in primary health care related to patient safety. The Design was an integrative literature review with an inductive approach. A mixed method with both qualitative and quantitative articles were used. Convergent parallel design was used to analyze the articles. Main findings. Triage in primary health care was judged to be safe for patients. Registered nurses had good communication skills that contributed to increased patient safety. However multiple factors that risked threatening patient safety were identified. Disadvantages identified in telephone triage were the flaws in the computerized decision support system and inadequacies in nurse’s communication skills among others. The walk-in centers needed to evolve but were considered to promote patient safety. Further education in triage and communication was requested to ensure patient safety. Conclusion. Triage in primary healthcare via telephone counseling is beneficial for patient safety. The results of the literature study also suggest that triage at walk-in centers is beneficial for patient safety, but further research is required to be able to investigate whether this result reflects reality. Registered nurses' communication skills can constitute both advantages and disadvantages of triage in primary health care in relation to patient safety, depending on whether the communication skills are good or lacking. Several factors are identified that risk threatening patient safety.