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Prioritering vid utlarmning i prehospital vård
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
2014 (Swedish)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, emergency medical dispatch centres (EMD) cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Increased knowledge about the triage in the prehospital care can make it possible to optimize the use of resources. Traditionally nurses have an important role in triage on emergency departments and in telephone advisory. In Sweden there is a trend towards more triage by nurses at EMDs. It is important to survey experiences of nurses’ of prioritization at EMDs.

Aim: The overall aim in this thesis was to measure effectivity in prioritisation of ambulance dispatches, and to elucidate experiences from these prioritizations and decisions.

Method: In study I sensitivity and specificity in 4086 dispatches was calculated, by comparison of the priority given by the EMD and the assessment performed by the ambulance-nurse according to Medical Emergency Triage and Treatment System. In study II were 15 nurses interviewed about their experiences from prioritizations at an EMD.

Result: The result showed that 84,5 % of the dispatches were correct prioritised and that the sensitivity was high (94,5 %) but the specificity was low (15,4 %). Content analysis was performed and two themes emerged: “Having a profession with opportunities and obstacles” and “Meeting serious and difficult situations”. Conclusions are that over- prioritizations are made concerning patients with low or no need of medical care. Also that nurses with experience from emergency care, who are allowed to make their own decisions independent of the medical index, can improve and nuance the prioritization of resources in prehospital care. However, there is an obvious risk that their assessments will tend to be on the safe side. Important for avoiding this is improving internal support systems at the EMDs and also striving for a blame-free culture, where the nurses are not pushed by threats of being reported.

Place, publisher, year, edition, pages
Örebro: Örebro universitet , 2014. , 62 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063
Keyword [en]
prioritization, experiences, triage, EMD, sensitivity, specificity, ambulance nurse
Keyword [sv]
larmcentral, triage, ambulanssjukvård, innehållsanalys, sensitivitet, specificitet
National Category
Medical and Health Sciences
Research subject
Nursing Science
Identifiers
URN: urn:nbn:se:oru:diva-38272OAI: oai:DiVA.org:oru-38272DiVA: diva2:759630
Presentation
2014-12-18, P247, Örebro, 14:10 (Swedish)
Opponent
Supervisors
Available from: 2015-03-20 Created: 2014-10-30 Last updated: 2015-12-28Bibliographically approved
List of papers
1. Reliability of a Swedish pre-hospital dispatch system in prioritizing patients
Open this publication in new window or tab >>Reliability of a Swedish pre-hospital dispatch system in prioritizing patients
2013 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, Vol. 21, no 2, 143-149 p.Article in journal (Refereed) Published
Abstract [en]

The need of emergency help often begins with a call to a dispatch center. The operator uses a medical index to prioritize dispatches. Since the resources of ambulances are limited, it is important that the priority grading decided by the operator at the dispatch center is as adequate as possible. In the county of Jamtland in Sweden, a system for triage named METTS-A (Medical Emergency Triage and Treatment System-A) has been in use since 2009, when the patient is coded according to priority level. The aim of this study was to analyse the sensitivity and specificity of the priority grading made by the dispatch center in comparison with the METTS-A priority assessed by the ambulance nurse. Statistics from a data-base in northern Sweden were analyzed. The material covered every ambulance that was dispatched, 6986 times during the period of data collecting. The results show a high sensitivity but low specificity in the dispatch system. The results also indicate that over prioritization exists since most of the patients with a high acute need of an ambulance are correctly identified, while many patients without that need are also given a high priority ambulance service. Therefore the conclusions were that both over- and under prioritizations were made.

Place, publisher, year, edition, pages
Elsevier, 2013
Keyword
Ambulance calls, Emergency calls, Pre-hospital
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-38265 (URN)10.1016/j.ienj.2011.11.006 (DOI)000319032400011 ()23615523 (PubMedID)2-s2.0-84876789260 (Scopus ID)
Available from: 2014-10-30 Created: 2014-10-30 Last updated: 2015-03-20Bibliographically approved
2. Registered nurses’ experiences of their decision-making at an Emergency Medical Dispatch Centre
Open this publication in new window or tab >>Registered nurses’ experiences of their decision-making at an Emergency Medical Dispatch Centre
2014 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702Article in journal (Refereed) Accepted
Abstract [en]

Aims and objectives: To describe registered nurses experiences at an Emergency Medical Dispatch Centre.

Background: It is important that ambulances are urgently directed to patients who are in need of immediate help and of quick transportation to a hospital. Because resources are limited, Emergency Medical Dispatch centres cannot send ambulances with high priority to all callers. The efficiency of the system is therefore dependent on triage. Nurses worldwide are involved in patient triage, both before the patients arrival to the hospital and in the subsequent emergency care. Ambulance dispatching is traditionally a duty for operators at Emergency Medical Dispatch centres, and in Sweden this duty has become increasingly performed by registered nurses.

Design: A qualitative design was used for this study.

Methods: Fifteen registered nurses with experience at Emergency Medical Dispatch centres were interviewed. The participants were asked to describe the content of their work and their experiences. They also described the most challenging and difficult situations according to the critical incidence technique. Content analysis was used.

Results: Two themes emerged during the analysis: ‘Having a profession with opportunities and obstacles’ and ‘Meeting serious and difficult situations’, with eight sub-themes. The results showed that the decisions to dispatch ambulances were both challenging and difficult. Difficulties included conveying medical advice without seeing the patient, teaching cardio-pulmonary resuscitation via telephone and dealing with intoxicated and aggressive callers. Conflicts with colleagues and ambulance crews as well as fear of making wrong decisions were also mentioned.

Conclusions: Work at Emergency Medical Dispatch centres is a demanding but stimulating duty for registered nurses.

Relevance to clinical practice: Great benefits can be achieved using experienced triage nurses, including increased patient safety and better use of medical resources. Improved internal support systems at Emergency Medical Dispatch centres and striving for a blame-free culture are important factors to attract and retain employees.

Place, publisher, year, edition, pages
John Wiley & Sons, 2014
Keyword
ambulance, content analysis, decision-making, emergency, priority, triage
National Category
Medical and Health Sciences Nursing
Identifiers
urn:nbn:se:oru:diva-38269 (URN)10.1111/jocn.12701 (DOI)
Available from: 2014-10-30 Created: 2014-10-30 Last updated: 2015-03-20Bibliographically approved

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