Patient trust and patient safety for low-priority patients: A randomized controlled trial pilot study in the prehospital chain of care

Boysen, Gabriella Norberg; Christensson, Lennart; Jutengren, Göran; Herlitz, Johan; Sundström, Birgitta Wireklint

doi:10.1016/j.ienj.2019.06.001

Cited by 12 publications

(10 citation statements)

References 22 publications

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“…A deeper description of experiences of the decision support through the specific collaboration however lacks. Other studies found a similar result of dialogue being important to establish trust (Norberg Boysen et al, 2017 ), and that patients cared for in PHC centres and EDs when calling for an ambulance have similar trust in the received care (Norberg Boysen et al, 2019 ). There is always an understanding gap in the dialogue due to encounters consisting of persons with different lifeworlds, meaning that previous experiences and knowledge affect the understanding of the situation (Dahlberg et al, 2008 ).…”

Section: Discussionmentioning

confidence: 72%

The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called

Forsgärde

Svensson

Rööst

et al. 2021

International Journal of Qualitative Studies on Health and Well

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Purpose This study aimed to describe extended collaboration in situations when an ambulance was called, as experienced by older patients, a significant other, and ambulance- and primary healthcare (PHC) centre personnel. Methods The study used a phenomenological reflective lifeworld research (RLR) approach. Participants included in three specific situations with extended collaboration were interviewed: three older patients, one significant other, three ambulance personnel and four personnel at the PHC centre. The transcribed interviews were analysed for meanings of the phenomenon. Results The extended collaboration means that decisions were supported through dialogue by bridging knowledge spaces between person, within-team and across-team levels. Through dialogue experience and knowledge were shared and certainty in decisions was increased. The extended collaboration was built on trust, responsibility taken, shared and entrusted, and the common goal of adapted care for the unique patient. A need for further improvement and transparency was elucidated. Conclusions The difficulty of making care decisions stresses the importance of available extended collaboration based on the dialogue between patients, significant others, and ambulance- and PHC centre personnel to increase certainty in decisions. Collaboration further requires respectful encounters, trust, responsibility and a common goal of adapting the care for the unique patient.

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Section: Discussionmentioning

confidence: 72%

The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called

Forsgärde

Svensson

Rööst

et al. 2021

International Journal of Qualitative Studies on Health and Well

View full text Add to dashboard Cite

show abstract

“…Care and treatment may be provided at the patient’s home and in a range of settings (indoor, outdoor, public, private, urban or rural), as well as in the ambulance or at a healthcare facility. These care decisions require extensive real-world experience, as any uncertainty can pose a threat to patient health and trust (Lindström et al, 2015; Norberg-Boysen, 2017; Rantala, 2017). Since 2005, Swedish law (National Board of Health and Welfare, 2009) requires the presence of an RN in every ambulance vehicle, and developments in Swedish EMS place increasing emphasis on the RN’s ability to assess patients, employing CR to ensure timely care and treatment and to make decisions about the most appropriate level of health care.…”

Section: Introductionmentioning

confidence: 99%

Clinical Reasoning among Registered Nurses in Emergency Medical Services: A Case Study

Andersson

Hagiwara

Sundström

et al. 2022

Journal of Cognitive Engineering and Decision Making

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In emergency medical services (EMS), the clinical reasoning (CR) of registered nurses (RNs) working in ambulance care plays an important role in providing care and treatment that is timely, accurate, appropriate and safe. However, limited existing knowledge about how CR is formed and influenced by the EMS mission hinders the development of service provision and decision support tools for RNs that would further enhance patient safety. To explore the nature of CR and influencing factors in this context, an inductive case study examined 34 observed patient–RN encounters in an EMS setting focusing on ambulance care. The results reveal a fragmented CR approach involving several parallel decision-making processes grounded in and led by patients’ narratives. The findings indicate that RNs are not always aware of their own CR and associated influences until they actively reflect on the process, and additional research is needed to clarify this complex phenomenon.

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“…So, how often are patients with a time-sensitive condition misclassified by the EMS as appropriate for self-care advice or primary care? In a randomised clinical trial among patients assessed by the EMS as candidates for primary care, Norberg Boysen et al found that 2% had a final diagnosis equivalent to a time-sensitive condition [ 24 ]. However, in a much larger proportion (31%), there was in retrospect hesitation as to whether the patients were true candidates for primary care [ 24 ].…”

Section: Main Textmentioning

confidence: 99%

Suboptimal prehospital decision- making for referral to alternative levels of care – frequency, measurement, acceptance rate and room for improvement

et al. 2022

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Background The emergency medical services (EMS) have undergone dramatic changes during the past few decades. Increased utilisation, changes in care-seeking behaviour and competence among EMS clinicians have given rise to a shift in EMS strategies in many countries. From transport to the emergency department to at the scene deciding on the most appropriate level of care and mode of transport. Among the non-conveyed patients some may suffer from “time-sensitive conditions” delaying diagnosis and treatment. Thus, four questions arise: How often are time-sensitive cases referred to primary care or self-care advice? How can we measure and define the level of inappropriate clinical decision-making? What is acceptable? How to increase patient safety? Main text To what extent time-sensitive cases are non-conveyed varies. About 5–25% of referred patients visit the emergency department within 72 hours, 5% are hospitalised, 1–3% are reported to have a time-sensitive condition and seven-day mortality rates range from 0.3 to 6%. The level of inappropriate clinical decision-making can be measured using surrogate measures such as emergency department attendances, hospitalisation and short-term mortality. These measures do not reveal time-sensitive conditions. Defining a scoring system may be one alternative, where misclassifications of time-sensitive cases are rated based on how severely they affected patient outcome. In terms of what is acceptable there is no general agreement. Although a zero-vision approach does not seem to be realistic unless under-triage is split into different levels of severity with zero-vision in the most severe categories. There are several ways to reduce the risk of misclassifications. Implementation of support systems for decision-making using machine learning to improve the initial assessment is one approach. Using a trigger tool to identify adverse events is another. Conclusion A substantial number of patients are non-conveyed, including a small portion with time-sensitive conditions. This poses a threat to patient safety. No general agreement on how to define and measure the extent of such EMS referrals and no agreement of what is acceptable exists, but we conclude an overall zero-vision is not realistic. Developing specific tools supporting decision making regarding EMS referral may be one way to reduce misclassification rates.

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Patient trust and patient safety for low-priority patients: A randomized controlled trial pilot study in the prehospital chain of care

Cited by 12 publications

References 22 publications

The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called

The dialogue as decision support; lived experiences of extended collaboration when an ambulance is called

Clinical Reasoning among Registered Nurses in Emergency Medical Services: A Case Study

Suboptimal prehospital decision- making for referral to alternative levels of care – frequency, measurement, acceptance rate and room for improvement

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