Municipal Acute Units as Part of the Clinical Pathway for Older Patients

Johannessen, Anne‐Kari; Steihaug, Sissel

doi:10.5334/ijic.4643

Cited by 13 publications

(9 citation statements)

References 36 publications

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“…In addition, ‘the loop’ was requested by physicians and nurses at the MAWs. In contrast, a recent study found that PCPs felt that the diagnostic loop was an inappropriate use of time and resources [ 31 ]. Managing diagnostic uncertainty has been reported as a recurring challenge for physicians [ 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…Hence, the PCPs seemed to lack insight into the nurses’ educational backgrounds and experience. Johannessen and Steihaug found that a lack of medical expertise was perceived as stressful and unsafe for nurses working in MAWs [ 31 ]. A Cochrane review indicated that nurse-led health services provide similar or better health outcomes, such as reduced mortality or reduced symptom burden for patients, than physician-led health services [ 40 ].…”

Section: Discussionmentioning

confidence: 99%

“…An interview guide (Additional file 1 ) was developed in accordance with the literature on healthcare quality at different healthcare levels, patient satisfaction, healthcare status, outcome measures and patient-centred care [ 18 , 19 , 29 – 31 ] and through iterative discussions between the authors until consensus was reached. The guide was pilot-tested for content and face validity through interviews with two experienced PCPs (both male), and small changes were made.…”

Section: Methodsmentioning

confidence: 99%

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What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance

Nystrøm

Lurås

Midlöv

et al. 2021

BMC Health Serv Res

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Background Due to demographic changes, hospital emergency departments in many countries are overcrowded. Internationally, several primary healthcare models have been introduced as alternatives to hospitalisation. In Norway, municipal acute wards (MAWs) have been implemented as primary care wards that provide observation and medical treatment for 24 h. The intention is to replace hospitalisation for patients who require acute admission but not specialist healthcare services. The aim of this study was to explore primary care physicians’ (PCPs’) perspectives on admission to a MAW as an alternative to hospitalisation. Methods The study had a qualitative design, including interviews with 21 PCPs in a county in southeastern Norway. Data were analysed with a thematic approach. Results The PCPs described uncertainty when referring patients to the MAW because of the fewer diagnostic opportunities there than in the hospital. Admission of patients to the MAW was assumed to be unsafe for both PCPs, MAW nurses and physicians. The PCPs assumed that medical competence was lower at the MAW than in the hospital, which led to scepticism about whether their tentative diagnoses would be reconsidered if needed and whether a deterioration of the patients’ condition would be detected. When referring patients to a MAW, the PCPs experienced disagreements with MAW personnel about the suitability of the patient. The PCPs emphasised the importance of patients’ and relatives’ participation in decisions about the level of treatment. Nevertheless, such participation was not always possible, especially when patients’ wishes conflicted with what PCPs considered professionally sound. Conclusions The PCPs reported concerns regarding the use of MAWs as an alternative to hospitalisation. These concerns were related to fewer diagnostic opportunities, lower medical expertise throughout the day, uncertainty about the selection of patients and challenges with user participation. Consequently, these concerns had an impact on how the PCPs utilised MAW services.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance

Nystrøm

Lurås

Midlöv

et al. 2021

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…In Norway, they have municipal acute units that are different from the Danish model. A Norwegian study found that the cross-collaboration was challenging because healthcare professionals had trouble with sharing information across sectors and different perceptions of which patients were candidates to stay at these units [ 29 ]. This study found the opposite to be true because the collaboration was going well, the main group of patients seemed to be clear and information exchange protocols were clear.…”

Section: Discussionmentioning

confidence: 99%

Healthcare professionals’ experiences with highly qualified nurses working in acute care teams in primary healthcare settings

Udesen

Lassen

Andersen

et al. 2021

Scandinavian Journal of Primary Health Care

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Objective: Strengthening primary healthcare with highly qualified nurses in acute care units or teams is a new Danish initiative intended to detect acute diseases and the deterioration of chronic diseases and to develop treatment for outpatients. This study explores healthcare professionals' experiences with this initiative. Design: Qualitative semi-structured interviews conducted in 2019-2020. Analysis was conducted with a systematic text condensation. Setting: This study is based on an acute care team in one Danish municipality called Acute Team Odense (ATO). ATO delivers acute nursing in patients' own homes (including nursing homes) in collaboration with different healthcare professionals. Subjects: Individual interviews with general practitioners (GPs) (n ¼ 15), five focus-group interviews with nurses and nursing assistants from the municipality (n ¼ 19) and one focus-group interview with staff from the emergency department (ED) (n ¼ 10). Main outcomes: Experiences of different healthcare professionals' experiences with ATO. Results: In general, all of the participants were very satisfied with the new acute care team and the cross-sectorial possibilities. The GPs usually referred ATO to assessments in which paraclinical equipment, competencies, accessibility, response time and communication were important. The municipal nurses and nursing assistants tended to use ATO if they needed second opinions or acute nurse assistance. The ED most often used ATO to assist with intravenous therapy after an ED visit. All participants reported that ATO increased what could be assessed and treated in patients' homes, which is central to preventing unnecessary hospitalisations. Conclusions: ATO created new possibilities in patient's homes which potentially might prevent unnecessary hospitalisations. KEY POINTSAcute care units or teams are mandatory in Danish health care, but limited knowledge in the area is found. Healthcare professionals found that the acute care teams provided new possibilities to assess and treat patients in their own homes. Healthcare professionals experienced that the acute care team potentially prevented hospitalisations by fast clinical nurse assessments with paraclinical tests.

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“…For future research, changes in the acute care pathways of older patients are needed to improve their care by providing alternatives to ED presentations, such as high urgency outpatient department 24 or the introduction of advanced care planning. 25 Furthermore, it would be interesting to see whether some causes are tied to perceived preventability more than others and to include other healthcare workers in the analysis of root causes.…”

Section: Discussionmentioning

confidence: 99%

Root causes and preventability of emergency department presentations of older patients: a prospective observational study

et al. 2021

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ObjectiveMore older patients are presenting to the emergency department (ED). It is important to know why these patients present and if the ED is the best place for them to receive the care they need. The primary aim of this study was to identify organisational-related, technical-related, healthcare worker-related and patient-related factors leading to ED presentations of older patients. The secondary aim was to determine patients’ and caregivers’ perspectives on what kinds of ED presentations are potentially preventable.DesignThis is a prospective observational study. A root cause analysis was performed by the Prevention and Recovery Information System for Monitoring and Analysis method. It used basic administrative data collected from patient records and interviews of patients, general practitioners (GPs) and physicians at the ED.SettingThe ED of an academic hospital in the Netherlands.Participants100 older patients (aged ≥70 years) who attended the ED between November 2017 and March 2018.ResultsIn 100 patients presenting to the ED, 159 factors that contributed to presentation were identified; most of these factors were related to underlying diseases (59%) and patient-related factors (18%). These presentations were considered potentially preventable by 23% of the physicians at the ED and 21% of the GPs, but only 10% of the patients. In only four cases was there overall agreement between the patients and the healthcare workers.ConclusionThe most frequent underlying factors contributing to an ED presentation in older patients are disease-related and patient-related. The low percentage of ED presentations considered potentially preventable shows that a ‘preventable ED presentation’ is difficult to define and therefore interventions to reduce them are unlikely to be simple. Novel solutions within the acute care pathway are required in order to deliver care of optimal quality and safety to older patients.

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Municipal Acute Units as Part of the Clinical Pathway for Older Patients

Cited by 13 publications

References 36 publications

What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance

What if something happens tonight? A qualitative study of primary care physicians’ perspectives on an alternative to hospital admittance

Healthcare professionals’ experiences with highly qualified nurses working in acute care teams in primary healthcare settings

Root causes and preventability of emergency department presentations of older patients: a prospective observational study

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