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Beskrivning av en akutmottagnings tillfällen av normalläge och dess tillfällen av emergency crowding/icke normala läge: Fokus patientsäkerhet
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
2014 (Swedish)Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
Abstract [sv]

Bakgrund: Normallägen på en akutmottagning karaktäriseras av att processflödena till läkare inom 60 minuter är i majoritet framför triageprocessflödena. Emergency crowding beskrivs inträffa närhelst resurserna inte räcker till för att möta patienternas vårdbehov/upprätthålla normalläge.

Syfte: Syftet med studien var att beskriva hur en akutmottagning såg ut avseende dess normala likaväl som dess icke normala lägen/tillfällen av emergency crowding. Intentionen var vidare att ur denna beskrivning identifiera orsaker/indikatorer för de båda lägena.

Metod: Studien hade en kvantitativ, retrospektiv och deskriptiv design som baserades på registerdata omfattande mängd, flödesprocesser och flödesprocesstider från en sjukhusbunden akutmottagning.

Resultat: Studien omfattades av registerdata baserade på totalt 2013 akutsökande under två studieveckor. Akutmottagningens resurser räckte totalt till för att upprätthålla ett normalläge i åtta och 12 ankomsttider beroende på studievecka. Inom dessa hade upp till 17-25 % av patienterna över 60-minuters processflöden till både läkare och triage och upp till 30-33 % läkarbedömdes inte inom triagetiden. De icke normala lägena inträffade i en majoritet av ankomsttiderna ena studieveckan och i hälften av ankomsttiderna den andra. Inom dessa hade upp till 55-56 % av patienterna över 60-minuters processflöden till läkare och triage och upp till 57-100 % av patienterna läkarbedömdes inte inom triagetiden. Medianakutbeläggningen var >100 % i en majoritet av ankomsttiderna. Sjuksköterskebemanningen var marginellt högre i samband med akutmottagningens normallägen medan patientinflödesfrekvenserna/60 minuter i princip såg likadana ut i normal- som i icke normala lägen. Totalt identifierades sju indikatorer för mottagningens normallägen samt för situationer av emergency crowding.

Slutsats: Frekvensen av emergency crowding var hög under aktuella studieveckor och orsakerna identifierades bero på: 1) Övergripande sjukvårds-/organisationsstuktur där behovet av akutmottagningen som snabbdiagnos- och utredningscenter var omfattande. 2) Mottagningens resurser, organisation och arbetssätt utifrån beskrivningen av processflödena adderat med den överlag höga medianakutbeläggningen. 3) Sjukhusets resurser och organisation utifrån resultaten av akutmedianvårdtiderna när behov av en sjukhussäng uppstod.

Abstract [en]

Background: Normal mode in an emergency department is characterized by the process streams as when the flows to physicians within 60 minutes are in the majority in front of the triage process flows. Emergency crowding/the emergency department´s non-normal mode is described to occur whenever there are insufficient resources to meet patient care needs/maintain normal mode.

Aim: The purpose with this study was to describe an emergency department due to its normal- as well as to its non-normal modes/situations of emergency crowding. From this, the over more intention was to identify causes/indicators for the both modes.

Method: The design of method was of quantitative, retrospective and descriptive design which was based on registry data extensive quantity, flow processes and flow processes time from a hospital emergency department.

Results: The study was covered by the registry data based on a total of 2013 acute applicants from two study weeks. The emergency departments’ resources were sufficient to maintain a normal-mode over eight to 12 arrival times depending on the study week. Within these had up to 17 % and 25 % of patients over 60-minutes process flows both to physician as to triage and up to 30-33 % weren’t assessed by physician within triage time. The non-normal modes occurred in a majority of the arrival time’s one study week and in half of arrival time’s in the other. Within these had up to 55-56 % of the patients over 60-minutes process flows both to physician as to triage and up to 57-100 % was not assessed by physician within triage time. The emergency occupancy rate was >100 % in a majority of the arrival times. Nursing staffing was marginally higher in relation to the clinics normal-modes while the patient inflow frequencies/60 minutes were basically the same in normal- as in non-normal modes. In total, seven indicators to normal- as to non normal modes were identified.

Conclusion: The frequency of emergency crowding was high in the current study weeks and was identified due to: 1) Overall healthcare organization structure where the need for the emergency department as prompt diagnosis and investigation centre was extensive. 2) The clinics’ resources, organizations and workings based on the description of the process streams added to the overall high median occupancy rate. 3) The hospital resources and organization due to median emergency length of stay when the need for a hospital bed arose.

Place, publisher, year, edition, pages
2014. , 57 p.
Keyword [en]
Emergency crowding, patient safety, emergency crowding: outcomes
National Category
Nursing
Identifiers
URN: urn:nbn:se:uu:diva-239298OAI: oai:DiVA.org:uu-239298DiVA: diva2:774068
Subject / course
Caring Sciences
Educational program
Freestanding course
Supervisors
Examiners
Available from: 2014-12-22 Created: 2014-12-22 Last updated: 2014-12-22Bibliographically approved

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