<p>Information overload förekommer på alla arbetsplatser där informationsbearbetning är viktigt för arbetsprocesserna. I vissa fall kan information overload medföra allvarliga konsekvenser både för den enskilda medarbetaren och för verksamheten i stort. På akutmottagningen på Centrallasarettet i Växjö har sjuksköterskorna en viktig roll som samordnare av den information som används i patientarbetet. Syftet med denna undersökning är att undersöka vilka faktorer som främst orsakar information overload hos sjuksköterskorna på akutmottagningen CLV, samt att undersöka hur fenomenet IO påverkar vårdkvaliteten.</p><p>Under mars och april 2007 genomfördes intervjuer med sju sjuksköterskor på den aktuella akutmottagningen utifrån en frågemall som utformats med hjälp av aktuell forskning på information overload. Resultatanalysen skedde utifrån en specifik orsakstabell som tagits från en litteratursammanställning av Eppler och Mengis (2004). Orsakstabellen utgår ifrån fem specifika områden - personliga faktorer, informationens karaktär, arbetsuppgifter och processparametrar, organisatorisk design samt informationsteknologi. Studien har genomförts utifrån en kvalitativ ansats.</p><p>Undersökningen visar att sjuksköterskorna på akutmottagningen ofta drabbas av information overload, och att riskfaktorer finns i samtliga fem ovanstående kategorier. Flera av deltagarna upplever regelbundet information overload-relaterade symtom och detta riskerar att hota patientsäkerheten på mottagningen. Dessutom leder det till minskad arbetstillfredsställelse hos sjuksköterskorna. Slutligen konstateras att en ordentlig informationsplan behöver upprättas för att rätta till de missförhållanden som orsakar information overload. Det är framför allt viktigt att informationen är relevant och hanterbar för att höja patientsäkerheten och vårdkvaliteten.</p> / <p>Information overload exists in all organisations where information processing is important for the work process. In some cases information overload is a serious threat to both the individual who suffers from it and to the organisation at large. At the emergency department at the Central Hospital in Växjö the nurses have an important function as coordinators of the information used in the patient treatments. The purpose of this study is to find out which factors primarily cause information overload in the emergency department and what implication this has on the quality of care given there.</p><p>In March and April of 2007 seven nurses were interviewed on the subject of information overload. Through a literary review relevant questions were formed for the interviews. The analysis of the answers were conducted from a table by Eppler and Mengis (2004) illustrating the causes of information overload. The table has five sub categories, personal factors, information characteristics, task and process parameters, organizational design and information technology. The study has a qualitative approach.</p><p>The result shows that the nurses at the ED are often affected by information overload, and that risk factors exist in all five sub categories mentioned above. Several nurses regularly experience symptoms caused by information overload, and this is a threat to patient safety at the ED. It also causes dissatisfaction in the daily work. Finally we conclude that a proper information plan is needed in order to find solutions to the problem. The information needs to be relevant and manageable to increase patient safety and the quality of care.</p>

The purpose of this mixed methods study was to describe the cognitive processes/knowledge sources used by Emergency Department (ED) nurses in decision-making activities regarding triage and pediatric pain assessment and management. Deficiencies persist in ED pediatric pain assessment, and management methods or approaches that might help resolve these deficiencies have not been identified previously. Methodology triangulation with sequential use of qualitative- quantitative methods provided a rich description of knowledge sources and cognitive processes used by ED nurses relative to pediatric pain assessment decisions. Based on qualitative results, a set of vignettes was developed to assess ED nurses. Data analysis using ordinal logistic regression with a cumulative logit model identified patient and nurse variables which influence triage acuity decisions. Five common themes emerged from the qualitative data; 1) Age of the child is important, 2) Behavior can tell a lot, 3) Really looking at the patient, 4) Things that help make decisions, and 5) Things that hinder decisions. Ordinal logistic regression analysis of the quantitative data identified predictor variables of infants compared to school-age children, Hispanic ethnicity, moderate number of years of ED experience (11 -20 years) and years of education that were associated with higher triage levels .The implications of this new knowledge include changes in ED triage nurse practice towards pain assessment, and increased awareness of the need for education in use of pain assessment tools. Additional implications include education related to pain management practices by ED physicians and pain medication protocols at triage. This information may enhance triage and care of the pediatric patient experiencing pain, expand the knowledge base of emergency nursing, identify areas in which to implement changes, assist in improving care provided to children experiencing pain, and provide direction for future education, training, and research.

BACKGROUND: A growing body of research has suggested that exposure to traffic-related emissions is associated with numerous adverse health effects including prevalence and severity of symptoms of asthma, hospitalizations for acute myocardial infarctions, and cardiovascular-related mortality. No previous studies have assessed the association between proximity to traffic and respiratory and cardiovascular outcomes across all age groups. OBJECTIVE: The purpose of this study was to assess the association between proximity to traffic emissions within the City of Atlanta and respiratory and cardiovascular 911 Emergency Management Service (EMS) calls and subsequent emergency department (ED) visits. METHODS: Case and control diagnostic groups were established for 5,450 EMS calls received between 2004 and 2008 from residents of the City of Atlanta based on ICD-9 codes assigned within the ED. Case diagnostic groups included asthma, cardiovascular outcomes, and stroke. Gastrointestinal diagnostic groups were selected as controls. Cumulative traffic within a 100 m buffer of the call origination location was used as an indicator of exposure to traffic emissions. Using a case-control study design, the associations between exposure to traffic emissions and the case diagnostic groups were evaluated using logistic regression, controlling for potential confounding factors including age, gender, ethnicity, and socio-economic status (SES). Subgroup analyses were performed to evaluate differences by select age categories, gender, and SES. P-values of <0.05 and 95% confidence intervals (CI) were used to determine statistical significance. RESULTS: Increased cumulative traffic near the call location was associated with an increase in the odds of an EMS call and ED visit for cardiovascular outcomes compared to the control diagnostic group even after adjustment for confounding factors (OR = 1.07; 95% CI ,1.01-1.12). The strongest effects were among men and individuals aged 40-75 years. Increased cumulative traffic was also associated with an increased odds of an EMS call and ED visit for stroke among individuals aged 18-39 years after adjusting for confounding (OR = 1.16; 95% CI, 1.01-1.34). No statistically significant associations were found between increased cumulative traffic and the odds of an EMS call and ED visit for asthma. CONCLUSION: These results provide additional evidence that proximity to traffic is associated with adverse cardiovascular outcomes and stroke in certain age groups.

Darbo tikslas – įvertinti skubios pagalbos skyrių pacientų lūkesčius. Darbo uždaviniai: 1. Įvertinti pacientų bendravimo su personalu lūkesčius; 2. Įvertinti pacientų laiko, kurį tikisi praleisti skubios pagalbos skyriuje, lūkesčius; 3. Nustatyti teikiamos pagalbos pirmumo bei informacijos valdymo lūkesčius; 4. Palyginti skirtingai savo sveikatos būklę vertinančių pacientų lūkesčius. Tyrimo metodika. Tyrimo objektas – skubios pagalbos skyrių pacientų lūkesčiai. Atlikta anketinė 411 pacientų, kurie 2008 02 25 – 2008 04 22 laikotarpiu naudojosi KMUK skubios pagalbos skyriaus paslaugomis, apklausa. Statistinė analizė atlikta naudojant “SPSS for Windows 13” programinį paketą. Rezultatai. Daugumai (65,7 – 94,6 proc.) pacientų svarbūs ir labai svarbūs buvo tiesioginio bendravimo su personalu aspektai. Mažiau svarbūs buvo netiesioginio bendravimo aspektai (38,4 – 42,6 proc.). 47,9 proc. respondentų nuomone, pacientai apie laukimo laiką turėtų būti informuojami kas 15 min. ir 41,8 proc. nuomone – kas 30 min. 48,7 proc. pacientų tikėjosi SPS praleisti iki 1 val., 31,6 proc. – nuo 1 iki 2 val. ir 16,3 proc. – nuo 2 iki 4 val. 64,7 proc. pacientų nuomone, pirmiausiai turėtų būti apžiūrėti sunkiausios būklės pacientai, 26,8 proc. - kenčiantys didžiausią skausmą ir 8,3 proc. - atvykę greitosios pagalbos automobiliu. 58,2 proc. respondentų nuomone, sveikatos kortelė iš šeimos gydytojo turėtų būti nedelsiant prieinama SPS gydytojui neklausus jų sutikimo, o 35 proc. - su paciento sutikimu... [toliau žr. visą tekstą] / Aim of the study – to evaluate patients expectations at emergency departments. Objectives: 1. To evaluate patients expectations regarding staff communication; 2. To evaluate waiting time expectations of the patients; 3. To evaluate the triage process and information management expectations; 4. To compare the expectations of patients with different self-rated health conditions. Methods. The subject of the research is patient expectations of emergency departments. Questionnaire survey was carried out among 411 patients who used the services of the emergency department of the Kaunas University Medical Hospital during the period of 25 02 2008 - 22 04 2008. The statistical analysis was performed by using the software SPSS for Windows 13. Results. The aspects of the direct staff communication were important or very important for the majority of the patients (65.7 – 94.6%). Less important were the aspects of indirect communication (38.4 – 42.6%). 47.9% of the respondents thought that patients must be informed of their waiting time every 15 minutes and 41.8% of respondents felt that patients must be updated every 30 minutes. 48.7% of patients expected to spend in emergency department up to 1 hour, 31.6% believed it would take from 1 to 2 hours and 16.3% of patients felt the length of stay there should be from 2 to 4 hours. 64.7% of patients believed that the patients with the most severe health problems should be seen first, 26.8% thought that these must be the patients suffering... [to full text]

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.

Background: There is currently no standard method of diagnosing the presence or severity of concussion in acute primary care settings. This pilot project is part of a larger study to develop a Computerized Concussion Assessment Tool (CCAT). Methods: A prospective observational clinical study was conducted to explore the validity of the CCAT among patients presenting to the Emergency Department at Kingston General Hospital and at Hotel Dieu Hospital (Kingston, Ontario) with minor head injury. Twenty-two patients with concussion and eighteen patients with head injury (but not diagnosed with concussion) were recruited to the study. All participants completed a background questionnaire, several neurocognitive tests and the CCAT assessment. Performance on the CCAT was compared between these two groups. Data collected during the development phase of the CCAT from a Normal Volunteers group (n=68) were used in an additional comparison. CCAT Scores for Selective Attention, Divided Attention and Memory were compared with standard neurocognitive tests through correlational analyses. In addition, the validity and clinical yield of the CCAT were investigated relative to gold standard measures. Results: After adjustment for covariates, no statistically significant differences were found between the three participant groups for any of the three primary CCAT Scores (Selective Attention, Divided Attention and Memory). Correlational analyses showed that the CCAT Selective Attention Score and the CCAT Memory Score are moderately correlated with standard neurocognitive tests. There was no correlation observed for the CCAT Divided Attention Score and its associated neurocognitive test. Conclusion: The CCAT was unable to discriminate between concussed patients and non-concussed individuals. However, moderate correlations observed between the CCAT Scores for Memory and Selective Attention and their respective neurocognitive tests support a view that there should be optimism for the future development of the CCAT. Issues related to the feasibility of the study and its administration in the emergency department setting are discussed. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2008-09-23 10:40:20.199

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Syfte: Att undersöka hur nöjda patienter 75 år och äldre är med vården som bedrivs på akutmottagningen på Akademiska sjukhuset i Uppsala avseende väntetid, miljö, kompetens, förtroende, tillgänglighet, bemötande, information, kommunikation och smärtlindring. Metod: Deskriptiv tvärsnittstudie. 38 patienter 75 år och äldre som besökt Akademiska sjukhusets akutmottagning svarade på en enkät avseende hur nöjda de var med sitt besök. Resultat: Patienter 75 år och äldre var i stort mycket nöjda över vården som bedrivs på Akademiska sjukhusets akutmottagning. Patienterna var minst nöjda över väntetiden som ibland ansågs vara för lång i relation till deras besvär. Ingen skillnad gick att utläsa mellan hur nöjda män och kvinnor var med vården avseende väntetid, miljö, kompetens, förtroende, tillgänglighet, bemötande, information, kommunikation och smärtlindring. Någon skillnad gick inte heller att utläsa mellan hur nöjda patienterna var med vården och vilken typ av besvär; medicinskt, kirurgiskt eller ortopediskt som patienten hade sökt för. Slutsats: Studien visar att de patienter 75 år och äldre som besvarade enkäten i stort är mycket nöjda med vården som bedrivs på Akademiska sjukhusets akutmottagning avseende väntetid, miljö, kompetens, förtroende, tillgänglighet, bemötande, information, kommunikation och smärtlindring. Resultaten går inte att generalisera och mer forskning krävs på området. / Aim: To investigate the satisfaction levels of patients aged 75 years and older for care received at the emergency department of Akademiska hospital in Uppsala with regard to waiting times, treatment environment, competence, patient trust, accessibility, treatment, information, communication and pain relief. Method: Descriptive cross section study. 38 patients aged 75 years and older who visited Akademiska’s emergency department answered by completing a form regarding how satisfied they were with their visit. Results: Patients aged 75 and older were generally very satisfied with the care offered by Akademiska’s emergency department. Patients were least satisfied with waiting times, which were sometimes felt to be too long in relation to their symptoms. No significant difference was recorded between the satisfaction levels between men and women for the care offered with regard to waiting times, treatment environment, competence, patient trust, accessibility, treatment, information, communication or pain relief. Neither were any significant differences recorded between the types of symptoms - medical, surgical or orthopaedic - that the patients were seeking treatment for. Conclusion: The study shows that patients aged 75 and over who answered the form were generally very satisfied with the care offered by Akademiska hospital’s emergency department with regard to waiting times, treatment environment, competence, patient trust, accessibility, treatment, information, communication and pain relief. These results cannot be generalized and more research is required in this area.

Bakgrund: Akutmottagningar har generellt ett hög patientflöde alla dagar på året. Hit söker sig människor med olika slags alla möjliga fysiska och psykiska besvär för att hjälp. Med en kraftig arbetsbörda, stressig arbetsmiljö och sjuka patienter ska sjuksköterskorna lyckas skapa vårdande möten med patienterna. Detta kan ibland vara besvärligt för sjuksköterskan då många faktorer påverkar relationen med patienten. Syfte: Att beskriva sjuksköterskans upplevelser av mötet med patienter på en akutmottagning. Metod: Empirisk studie med kvalitativ ansats. Fem sjuksköterskor intervjuades på en akutmottagning. Data analyserades med hjälp av innehållsanalys. Resultat: Studien resulterade i fyra huvudområden; Det goda mötet, Kommunikation, Professionalitet och Det dåliga mötet. För att skapa en positiv vårdande relation beskriver sjuksköterskorna känslan av en personlig kontakt med patienten. Vikten av en god kommunikation och ett professionellt förhållningssätt belyses för att ett vårdande möte ska uppkomma. Klinisk betydelse: Denna studie kan för personalen vara ett hjälpmedel till att se sina upplevelser i ett större sammanhang. För verksamheten kan studien hjälpa till att lyfta frågan kring vikten av patientbemötande och visa hur erfarna medarbetare gör för att lyckas skapa goda möten med patienter. Att av nyanställda få en inblick i hur erfarna kollegor agerar och tänker i möten med patienter, för att då få ett bredare perspektiv och möjligtvis kunna dra lärdom av hur de goda och mindre goda mötena skapades. / Background: Emergency departments generally have a high patient flow every day of the year. Here people seek help for all sorts of physical and psychological disorders. With a heavy workload, stressful work environment and sick patients, nurses need to succeed in creating caring encounters with patients. This can sometimes be difficult for the nurse because many factors affect the relationship with the patient. Aim: To describe nurses' experiences of meeting with patients in an emergency department. Method: Empirical study with a qualitative approach. Five nurses were interviewed in an emergency department. The data was analyzed using content analysis. Result: The study resulted in four main areas: The good encounter, Communication, Professionalism and The bad encounter. To create a positive caring relationship the nurses describe the feeling of a personal connection with the patient. The importance of a good communication and a professional approach is illustrated for a caring meeting to occur. Clinical significance: This study can be an aid for the staff to see their experiences in a bigger context. For the ward this study could help to lift the subject of the importance of patient encounters and to show how experienced co-workers manages to create positive encounters with patients. That recently hired staff can get a glimpse of how experienced colleges acts and thinks in various patient encounters, to get a broader perspective and possibly be able to learn from the way the good and bad encounters were created.