BackgroundA new generation of ear thermometers with preheated tips and several measurements points should allow a more precise temperature measurement. The aim of the study was to evaluate if the ear temperature measured by this ear thermometer can be used to screen for fever and whether the thermometer is in agreement with the rectal temperature and if age, use of hearing devices or time after admission influences the temperature measurements.MethodsOpen cross-sectional clinical single site study patients, > 18 years old, who were acutely admitted to the short stay unit at the ED. A sample size of 99 patient per subgroup was recruited as random convenience series. As ear thermometer Braun Thermoscan Pro 4000® and as rectal thermometer Omron Flex Temp Smart ® was used. For different cut off of temperature the AUC was calculated and Bland-Altman analysis for calculation of 95% limits of agreement with rectal temperature, with subgroup analysis concerning age, time span from admission time and use of hearing aid.ResultsAmong 599 patients the sensitivity to detect fever with an ear thermometer varied between 68 and 70% with AUC from 0.88–0.97. If the ear temperature was ≥37.5 oC, the sensitivity to detect patients with ≥38.0 oC rectally was 95% which raised to 100% for a rectal temperature of ≥38.3 oC. For the ear thermometer’s ability to determine the exact temperature the 95% limits of agreement were +/− 0.8 oC. with no influence from age, duration of hospital stay or hearing aids.ConclusionThe examined ear thermometer is able to detect fever, defined as ≥38 oC rectally in an adult ED population by using an ear cut-point of 37.5 oC, but not to measure the exact temperature. Used in this way around a fifth of the patients will still be in need of a rectal temperature measurement, but less than 5% with fever ≥38.0 oC will remain undetected and none with fever ≥38.3 oC. Age, admission time and use of hearing aid did not influence the temperature measurements.Trial registrationClinical Trials: ID NCT02977481, date 11/18/2016.
Background Healthcare services have become more complex, globally and nationally. Denmark is renowned for an advanced and robust healthcare system, aiming at a less fragmented structure. However, challenges within the coordination of care remain. Comprehensive restructures based on marketization and efficiency, e.g. New Public Management (NPM) strategies has gained momentum in Denmark including. Simultaneously, changes to healthcare professionals’ identities have affected the relationship between patients and healthcare professionals, and patient involvement in decision-making was acknowledged as a quality- and safety measure. An understanding of a less linear patient pathway can give rise to conflict in the care practice. Social scientists, including Jürgen Habermas, have highlighted the importance of communication, particularly when shared decision-making models were introduced. Healthcare professionals must simultaneously deliver highly effective services and practice person-centered care. Co-morbidities of older people further complicate healthcare professionals’ practice. Aim This study aimed to explore and analyse how healthcare professionals’ interactions and practice influence older peoples’ clinical care trajectory when admitted to an emergency department (ED) and the challenges that emerged. Methods This qualitative study arises from a hermeneutical stand within the interpretative paradigm. Focusing on the healthcare professionals’ interactions and practice we followed the clinical care trajectories of seven older people (aged > 65, receiving daily homecare) acutely hospitalized to the ED. Participant observations were combined with interviews with healthcare professionals involved in the clinical care trajectory. We followed-up with the older person by phone call until four weeks after discharge. The study followed the code of conduct for research integrity and is reported in accordance with the Standards for Reporting Qualitative Research (SRQR) guidelines. Results The analysis revealed four themes: 1)“The end justifies the means – ‘I know what is best for you’”, 2)“Basic needs of care overruled by system effectiveness”, 3)“Treatment as a bargain”, and 4)“Healthcare professionals as solo detectives”. Conclusion Dissonance between system logics and the goal of person-centered care disturb the healthcare practice and service culture negatively affecting the clinical care trajectory. A practice culture embracing better communication and more person-centered care should be enhanced to improve the quality of care in cross-sectoral trajectories.
Background The number of older people is increasing, resulting in more people endure chronic diseases, multimorbidities and complex care needs. Insufficient care coordination across healthcare sectors has negative consequences for health outcomes, costs and patient evaluation. Despite introducing initiatives to solve coordination challenges within healthcare, the need remains for more consistent solutions. In particular, improved care coordination would benefit older adults characterised by complex care needs, high use of healthcare resources and multiple care providers. Aims and objectives To identify and analyse healthcare professionals’ perspectives and approaches to care coordination across sectors when older people are acutely hospitalised. Design Qualitative interview study. Methods Semi-structured, individual interviews with 13 healthcare professionals across health sectors and professions were conducted. The strategy for the qualitative analysis was inspired by Kirsti Malterud and labelled ‘systematic text condensation’. This strategy is a descriptive and explorative method for thematic cross-case analysis of qualitative data. Results Four themes/categories emerged from the analysis; “Organisational factors”, “Approaches to care”, “Communication and knowledge”, and “Relations”. Conclusion Different organisational cultures can discourage intersectoral care coordination. Approaches to care vary at all levels across health sectors and professions. Organisational, leadership and professional identity affect the working cultures and must be considered in the future recruitment and socialisation of healthcare staff. Our research suggests that combinations of healthcare standardisations and flexible, adaptive solutions are required to improve intersectoral care coordination.
BackgroundInterdisciplinary collaboration in rheumatology rehabilitation is pivotal in order to meet the complex and multifaceted needs of the patients.1 However, in practice, an interprofessional approach is hard to achieve.2 ObjectivesTo explore how health professionals working with inpatient rehabilitation at a Danish hospital for rheumatic diseases, experience the interdisciplinary collaboration in practice compared to their ideals. Further, to explore what fosters or prevents interprofessional collaboration.MethodsIn total six focus groups and two individual interviews were conducted with 32 health professionals (HPs) working with rehabilitation. The HPs included occupational therapists, physiotherapists, rheumatologists, nursing staff, a social worker and a dietician. The composition of the focus groups were monodisciplinary, except from one group where nurses and doctors from the outpatient unit were interviewed together. The individual interviews were conducted with a social worker and a dietician, as they were sole employers within these disciplines.The interviews were transcribed ad verbatim and a thematic condensation and indexing was used in the analysis of the data.3 ResultsThe analysis revealed a clash between ideals about interdisciplinary teamwork and the dominant monodisciplinary work practice. Physical, organisational and cultural factors were perceived as important barriers. Lack of common physical facilities hindered both informal and formal interdisciplinary cooperation. The organisational set up with only one interdisciplinary team meeting before the patients were admitted to hospital and with a lack of rheumatologists’ involvement during admission did not support interdisciplinary teamwork. The existing monodisciplinary work culture acted as a barrier towards both formal and informal collaboration. All these factors led to a lack of knowledge about the contributions from other HPs.Common physical work and meeting facilities and informal networking fostered interprofessional collaboration.ConclusionsTo support the development of interprofessional teamwork in rehabilitation practice, it is important to consider both common physical work facilities and to change the organisational and cultural factors acting as barriers towards collaboration. Further knowledge about the contributions from other HPs is a prerequisite to interprofessional collaboration.References[1] Bearne LM, et al. Multidisciplinary team care for people with rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology International2016;36:311–324.[2] Wade D. Rehabilitation – a new approach. Part three: the implications of the theories. Clinical Rehabilitation2016;30(1):3–10.[3] Miles MB, Huberman M. Qualitative Data Analysis. London, Thousand Oaks, CAand New Delhi: Sage Publications1974.Disclosure of InterestNone declared
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