Discharge instructions provided to patients discharged from the emergency department (ED) are often provided in a way that is neither clear nor concise. Patients are often discharged home without a clear understanding of their diagnosis, medications, reasons to return to the ED, follow-up instructions, or how to manage their care at home during their illness. Therefore, a guideline needed to be developed in order to help the ED staff provide clear and concise discharge instructions to patients discharged from the ED. The Ace Star Model of Knowledge Transformation was the foundation for the development of the evidence-based guideline. A formative group of 7 individuals was created to critique the initial draft of the guideline, and a final version of the guideline was then distributed to 10 medical professionals to aid in the approval and determination of the quality of the guideline. The data analysis from the formative group questionnaire, and the appraisal of guidelines for research and evaluation tool led to the recommendations for a guideline on the delivery of evidence-based discharge instructions. This project has implications for social change in practice by (a) increasing the awareness among medical professionals about the importance of their communication style on patient discharge and (b) allowing for more efficient communication to occur between them and their patients. The use of an evidence-based practice guideline for providing discharge instructions to patients discharged from the ED will allow improved quality of care to patients, efficient communication between the healthcare providers and patients, a positive impact for social change in practice, and a consistent and reliable method for patients to understand their discharge instructions in a way that is clear and concise.

Sepsis is the leading cause of death among hospitalized patients in the United States, is responsible for more than 200,000 deaths annually, and has as high as a 50% mortality rate. Sepsis requires prompt identification so that early goal-directed therapy can be instituted to lead to better outcomes. The purpose of this quality improvement project was to determine if implementing an evidence-based identification and intervention program, Project Code Sepsis, in the emergency department can increase the number of patients who receive antibiotics within the first hour of triage and decrease the length of hospital stay. Specifically, the primary project goals were: (a) to administer initial antibiotic treatments within 1 hour of triage to more than 75% of patients, and (b) to reduce length of hospital stay to an average of less than 7 days. The project was developed from the Donabedian Healthcare Quality Triad and guided by the Six Sigma DMAIC method. A total of 306 patients were included in this project conducted from May to October 2015. The sepsis-screening tool was fully implemented during August when more than 75% of patients received their initial antibiotic within one hour of triage time. However, this accomplishment was not sustained during the next two months. Interestingly, August was also the month with the highest length of hospital stay (7.49 days) among sepsis patients. This quality improvement project did not show that the provision of antibiotic therapy within the first hour of triage time decreases the length of hospital stay among sepsis patients. Multiple factors including administration of intravenous fluids and vasopressors for hypotension, nurse and physician experiences, patient acuity, and local sepsis bacteria profile should be considered together in future studies and quality improvement projects.

<p>Inom akutsjukvården är en stor del patienterna 65 år och äldre, vilket innebär att en stor del av vården vid en akutmottagning omfattas av bemötande och omhändertagande av äldre patienter. <strong>Syfte: </strong>Syftet med denna studie var att belysa hur äldre personer beskriver att deras behov av omvårdnad blir tillgodosett av omvårdnadspersonal vid akutmottagning. <strong>Metod: </strong>Studien genomfördes som en litteraturstudie där 13 artiklar granskades. <strong>Resultat: </strong>Resultatet visade att många äldre hade en negativ upplevelse av sin vistelse på akutmottagningen. Många fick vänta länge och fick inte sina basala behov tillgodosedda såsom t.ex. mat och dryck. Äldre patienter kände sig oroliga, övergivna och rädda under väntetiden och önskade mer uppmärksamhet och en mer kontinuerlig uppföljning under väntetiden. Resultatet visade också att information till patienten var väldigt viktig. Fick de äldre på akutmottagningen information om vad som skulle hända, hur undersökningar skulle gå till och varför de fick vänta kände de sig nöjda och trygga. Det fanns enligt resultatet en hög respekt för sjuksköterskornas professionella kompetens och omvårdnadspersonalens uppträdande på akutmottagning värderades högre av äldre patienter än av yngre patienter.</p> / <p>In the emergency department a big part of the patients are 65 years old and older, which means that a great deal of the medical care at the emergency department consists of meeting and caring for older patients. <strong>The aim</strong>: The aim with this study was to enlighten how the older patients describe that nurses at the emergency department provide for their need of care. <strong>Method: </strong>The study was done as a study of literature where 13 articles were reviewed. <strong>Result: </strong>The result showed that several older patients had a negative experience of their stay at the emergency department. Many of them had to wait for a long time and did not get their needs provided for. Older patients felt worried, abandon and scared during their time waiting and wished for more attention and more continual checkups during waiting time. The result also showed that information to the patients where very important. If the older patients at the emergency department got information about what was going to happen, how the examinations should proceed and why they had to wait they got more satisfied and secure as patients. There was, according to the result, a high respect for the nurse’s professional competence, and the older patients valued the staff’s behaviour higher than the younger patients.</p>

<p>To sort, is the meaning of the word “triage”. Triage is used at emergency departments to facilitate prioritization of patients according to the urgency of the chief complaint.<em> </em>The aim of this study was to investigate how the nurses experience the triage model at the emergency department at Uppsala university hospital.</p><p>Twelve nurses were interviewed. The mean age was 40 years and the mean work experience was three years and four months. An interview guide was used, consisting of questions about triage, collaboration and work situation.</p><p>The nurses perceived that triage supports assessment and prioritization of patients. Different triage models were used depending on the nurses’ level of triage-education, which was perceived as problematic. The nurses perceived safety when triage was performed together with the physician. The level of collaboration, between the nurses and the physicians, was experienced to be person-dependent. The importance of good communication between nurses and physicians were highlighted.</p><p>Triage supports the assessment and prioritization of patients.<strong> </strong>A standardized triage model would increase the quality of care. The collaboration between nurses and physicians could be improved if they receive the same information and education about triage. Improved communication will facilitate the collaboration. Physicians should participate in the triage process.</p>

<p>The purpose of this study was to investigate registered nurses experiences about the current model for triage at the emergency department at Uppsala University Hospital. The study is descriptive with qualitative approach. The data collection was made in the form of semi structured interviews. The interviews took place at the emergency department. The sample consisted of eight registered nurses with varying work experience of emergency care. The interviews were transcribed and analyzed. The content analysis resulted in 14 categories and four themes.</p><p>The main result contains both positive and negative experiences concerning registered nurses situation when working with team triage. Team triage has improved the work in many aspects: it runs more smoothly and inspires to a good working climate. At the same time the informants experienced the lack of guidelines on how team triage should be conducted. Working in team has improved the cooperation with the physicians. An important factor to this is good communication. However, numerous of the informants felt that they were of no use when working in team. It was also a lack of interest from the physicians of working in team with registered nurses. Further research is required on this topic to develop and improve the way to work with team triage.</p>

This thesis presents the results of three studies examining the management of migraine in children. First we conducted a systematic review of all clinical trials conducted in children and adolescents of the acute migraine therapy. A meta-analysis of the 26 randomized controlled trials is presented. A single trial with a focus on Emergency Department (ED) management was identified. As such, we then examined current ED practice in two retrospective practice variation studies. The first compared four regional hospital EDs where practice patterns were significantly different between mixed population EDs (both adult and pediatric patients) and the tertiary pediatric ED. The second examined practice variation among ten tertiary pediatric EDs in Canada where significant differences were again observed. Factors that influenced the choice of medications included increasing patient age and the physicians diagnosis of migraine. Important areas of future investigation include: (1) the effectiveness of intravenous fluids alone; and (2) the use of combined medications. / Clinical Epidemiology

The purpose of this study was to investigate registered nurses experiences about the current model for triage at the emergency department at Uppsala University Hospital. The study is descriptive with qualitative approach. The data collection was made in the form of semi structured interviews. The interviews took place at the emergency department. The sample consisted of eight registered nurses with varying work experience of emergency care. The interviews were transcribed and analyzed. The content analysis resulted in 14 categories and four themes. The main result contains both positive and negative experiences concerning registered nurses situation when working with team triage. Team triage has improved the work in many aspects: it runs more smoothly and inspires to a good working climate. At the same time the informants experienced the lack of guidelines on how team triage should be conducted. Working in team has improved the cooperation with the physicians. An important factor to this is good communication. However, numerous of the informants felt that they were of no use when working in team. It was also a lack of interest from the physicians of working in team with registered nurses. Further research is required on this topic to develop and improve the way to work with team triage.

To sort, is the meaning of the word “triage”. Triage is used at emergency departments to facilitate prioritization of patients according to the urgency of the chief complaint. The aim of this study was to investigate how the nurses experience the triage model at the emergency department at Uppsala university hospital. Twelve nurses were interviewed. The mean age was 40 years and the mean work experience was three years and four months. An interview guide was used, consisting of questions about triage, collaboration and work situation. The nurses perceived that triage supports assessment and prioritization of patients. Different triage models were used depending on the nurses’ level of triage-education, which was perceived as problematic. The nurses perceived safety when triage was performed together with the physician. The level of collaboration, between the nurses and the physicians, was experienced to be person-dependent. The importance of good communication between nurses and physicians were highlighted. Triage supports the assessment and prioritization of patients. A standardized triage model would increase the quality of care. The collaboration between nurses and physicians could be improved if they receive the same information and education about triage. Improved communication will facilitate the collaboration. Physicians should participate in the triage process.

Inom akutsjukvården är en stor del patienterna 65 år och äldre, vilket innebär att en stor del av vården vid en akutmottagning omfattas av bemötande och omhändertagande av äldre patienter. Syfte: Syftet med denna studie var att belysa hur äldre personer beskriver att deras behov av omvårdnad blir tillgodosett av omvårdnadspersonal vid akutmottagning. Metod: Studien genomfördes som en litteraturstudie där 13 artiklar granskades. Resultat: Resultatet visade att många äldre hade en negativ upplevelse av sin vistelse på akutmottagningen. Många fick vänta länge och fick inte sina basala behov tillgodosedda såsom t.ex. mat och dryck. Äldre patienter kände sig oroliga, övergivna och rädda under väntetiden och önskade mer uppmärksamhet och en mer kontinuerlig uppföljning under väntetiden. Resultatet visade också att information till patienten var väldigt viktig. Fick de äldre på akutmottagningen information om vad som skulle hända, hur undersökningar skulle gå till och varför de fick vänta kände de sig nöjda och trygga. Det fanns enligt resultatet en hög respekt för sjuksköterskornas professionella kompetens och omvårdnadspersonalens uppträdande på akutmottagning värderades högre av äldre patienter än av yngre patienter. / In the emergency department a big part of the patients are 65 years old and older, which means that a great deal of the medical care at the emergency department consists of meeting and caring for older patients. The aim: The aim with this study was to enlighten how the older patients describe that nurses at the emergency department provide for their need of care. Method: The study was done as a study of literature where 13 articles were reviewed. Result: The result showed that several older patients had a negative experience of their stay at the emergency department. Many of them had to wait for a long time and did not get their needs provided for. Older patients felt worried, abandon and scared during their time waiting and wished for more attention and more continual checkups during waiting time. The result also showed that information to the patients where very important. If the older patients at the emergency department got information about what was going to happen, how the examinations should proceed and why they had to wait they got more satisfied and secure as patients. There was, according to the result, a high respect for the nurse’s professional competence, and the older patients valued the staff’s behaviour higher than the younger patients.

Background: An emergency department (ED) should offer timely care for acutely ill or injured persons that require the attention of specialized nurses and physicians. This study was aimed at exploring what is actually going on at an ED. Methods: Qualitative data was collected 2009 to 2011 at one Swedish ED (ED1) with 53.000 yearly visits serving a population of 251.000. Constant comparative analysis according to classic grounded theory was applied to both focus group interviews with ED1 staff, participant observation data, and literature data. Quantitative data from ED1 and two other Swedish EDs were later analyzed and compared with the qualitative data. Results: The main driver of the ED staff in this study was to reduce non-acceptable waiting. Signs of non-acceptable waiting are physical densification, contact seeking, and the emergence of critical situations. The staff reacts with frustration, shame, and eventually resignation when they cannot reduce non-acceptable waiting. Waiting management resolves the problems and is done either by reducing actual waiting time by increasing throughput of patient flow through structure pushing and shuffling around patients, or by changing the experience of waiting by calming patients and feinting maneuvers to cover up. Conclusion: To manage non-acceptable waiting is a driving force behind much of the staff behavior at an ED. Waiting management is done either by increasing throughput of patient flow or by changing the waiting experience.