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1.
Emerg Med J ; 2024 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-39288976

RESUMO

BACKGROUND: Calls to emergency departments (EDs) from ambulances to alert them to a critical case being transported to that facility that requires a special response ('pre-alerts') have been shown to improve outcomes for patients requiring immediate time-critical treatment (eg, stroke). However, little is known about their usefulness for other patients and the processes involved in ED responses to them. This study aimed to understand how pre-alerts influence patient care in the ED. METHODS: We undertook non-participant observation (162 hours, 143 pre-alerts) and semi-structured interviews with staff (n=40) in six UK EDs between August 2022 and April 2023 focusing on how ED staff respond to pre-alert calls and what influences their response. Observation notes and interview transcripts were imported into NVivo and analysed using a thematic approach. RESULTS: Pre-alert calls involved significant time and resources for ED staff but they were valued as they enabled staff to prepare for a patient's arrival (practically and psychologically). High demand and handover delays at ED created additional pre-alerts due to ambulance clinician concerns about the impact of long waits on patients.Despite the risk of pre-alert fatigue from calls for patients considered not to require a special response, ED clinicians appreciated timely pre-alert information, perceiving a higher risk from underalerting than overalerting. Variation in ED response was influenced by individual and organisational factors, particularly the resources available at the time of pre-alert. Unclear ED processes for receiving, documenting and sharing information about pre-alerts increased the risk of information loss. CONCLUSION: Improving processes for receiving and sharing pre-alert information may help ED clinicians prepare appropriately for incoming patients. Alternative routes for ambulance clinicians to seek advice on borderline pre-alert patients may help to improve the appropriateness of pre-alerts.

2.
Emerg Med J ; 2024 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-39153848

RESUMO

BACKGROUND: Ambulance clinicians use pre-alerts to inform receiving hospitals of the imminent arrival of a time-critical patient considered to require immediate attention, enabling the receiving emergency department (ED) or other clinical area to prepare. Pre-alerts are key to ensuring immediate access to appropriate care, but unnecessary pre-alerts can divert resources from other patients and fuel 'pre-alert fatigue' among ED staff. This research aims to provide a better understanding of pre-alert decision-making practice. METHODS: Semi-structured interviews were conducted with 34 ambulance clinicians from three ambulance services and 40 ED staff from six receiving EDs. Observation (162 hours) of responses to pre-alerts (n=143, call-to-handover) was also conducted in the six EDs. Interview transcripts and observation notes were imported into NVIVO and analysed using thematic analysis. FINDINGS: Pre-alert decisions involve rapid assessment of clinical risk based on physiological observations, clinical judgement and perceived risk of deterioration, with reference to pre-alert guidance. Clinical experience (pattern recognition and intuition) and confidence helped ambulance clinicians to understand which patients required immediate ED care on arrival or were at highest risk of deterioration. Ambulance clinicians primarily learnt to pre-alert 'on the job' and via informal feedback mechanisms, including the ED response to previous pre-alerts. Availability and access to clinical decision support was variable, and clinicians balanced the use of guidance and protocols with concerns about retention of clinical judgement and autonomy. Differences in pre-alert criteria between ambulance services and EDs created difficulties in deciding whether to pre-alert and was particularly challenging for less experienced clinicians. CONCLUSION: We identified potentially avoidable variation in decision-making, which has implications for patient care and emergency care resources, and can create tension between the services. Consistency in practice may be improved by greater standardisation of guidance and protocols, training and access to performance feedback and cross-service collaboration to minimise potential sources of tension.

3.
BMJ Open ; 13(8): e070016, 2023 09 12.
Artigo em Inglês | MEDLINE | ID: mdl-37699606

RESUMO

OBJECTIVE: The primary and secondary impacts from the COVID-19 pandemic are claimed to have had a detrimental impact on health professional retention within the UK National Health Service (NHS). This study set out to identify priorities for intervention by scaling the relative importance of widely cited push (leave) influences. DESIGN: During Summer/Autumn 2021, a UK-wide opportunity sample (n=1958) of NHS health professionals completed an online paired-comparisons exercise to determine the relative salience of work-related stress, workload intensity, time pressure, staffing levels, working hours, work-homelife balance, recognition of effort and pay as reasons why health professionals leave NHS employment. SETTING: The study is believed to be the first large-scale systematic assessment of factors driving staff exits from the NHS since the COVID-19 pandemic. RESULTS: All professions gave primacy to work-related stress, workload intensity and staffing levels. Pay was typically located around the midpoint of the respective scales; recognition of effort and working hours were ranked lowest. However, differences were apparent in the rank order and relative weighting of push variables between health professions and care delivery functions. Ambulance paramedics present as an outlier, notably with respect to staffing level (F-stat 4.47, p=0.004) and the primacy of work-homelife balance. Relative to staffing level, other push variables exert a stronger influence on paramedics than nurses or doctors (f 4.29, p=0.006). CONCLUSION: Findings are relevant to future NHS health professional retention intervention strategy. Excepting paramedics/ambulance services, rankings of leave variables across the different health professional families and organisation types exhibit strong alignment at the ordinal level. However, demographic differences in the weightings and rankings, ascribed to push factors by professional family and organisation type, suggests that, in addition to signposting universal (all-staff) priorities for intervention, bespoke solutions for different professions and functions may be needed.


Assuntos
COVID-19 , Estresse Ocupacional , Humanos , Medicina Estatal , Análise por Pareamento , Pandemias , COVID-19/epidemiologia , Emprego , Reino Unido
4.
J Health Organ Manag ; ahead-of-print(ahead-of-print)2021 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-33619923

RESUMO

PURPOSE: A process that does not include the customer's value may not be effective in providing care. This study aimed to identify value and waste in an emergency department (ED) patient flow process from a patient and clinician perspective. DESIGN/METHODOLOGY/APPROACH: A qualitative case study was conducted in an ED in Trinidad and Tobago. Observations and informal conversational interviews with clinicians (n = 33) and patients (n = 50) explored patient flow, value and waste. Thematic analysis was used to create a framework on valuable and wasteful aspects in the ED patient flow process. FINDINGS: Valuable aspects led to direct improvements in the patient's health or an exchange of information in the process. Wasteful aspects were those with no patient activity, no direct ED clinical involvement, or resulted in a perceived inappropriate use of ED resources. However, there was a disparity in responses between clinicians and patients with clinicians identifying more features in the process. RESEARCH LIMITATIONS/IMPLICATIONS: The single case study design limits the generalizability of findings to other settings. This study did not specifically explore the influence of age and gender on what mattered to patients in ED services. Future studies would benefit from exploring whether there are any age and gender differences in patient perspectives of value and waste. Further research is needed to validate the usefulness of the framework in a wider range of settings and consider demographic factors such as age and gender. PRACTICAL IMPLICATIONS: The study has produced a framework which may be used to improve patient flow in a way that maximized value to its users. A collaborative approach, with active patient involvement, is needed to develop a process that is valuable to all. The single case study design limits the generalizability of findings to other settings. ORIGINALITY/VALUE: Qualitative methods were used to explicitly explore both value and waste in emergency department patient flow, incorporating the patient perspective. This paper provides an approach that decision makers may use to refine the ED patient flow process into one that flows well, improves quality and maximizes value to its users.


Assuntos
Comunicação , Serviço Hospitalar de Emergência , Humanos , Participação do Paciente , Pesquisa Qualitativa
5.
BMJ Open ; 11(2): e048007, 2021 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-33550271

RESUMO

OBJECTIVE: A national system of Medical Examiners (MEs) implemented in England and Wales from April 2019 was intended to ensure that every death receives scrutiny from an independent, senior doctor, resulting in early detection of problems in care. The aim of this study was to increase understanding of how the ME role operates to identify problems related to quality of patient care and to explore the potential for development to maximise learning opportunities. DESIGN: A qualitative approach involved the use of semi-structured interviews. Data analysis employed a framework approach. SETTING: Study participants were recruited from 11 acute hospitals in England, known to be operating an ME service. PARTICIPANTS: A purposive sample of 20 MEs and one ME officer. RESULTS: MEs brought different perspectives to the role based on their medical background. The process for identifying and acting on quality of care concerns was broadly consistent, with a notable consensus regarding the value of speaking to bereaved relatives. Variation was identified within and between services in relation to how core components are carried out and the perceived salience of information, which appeared to reflect individual and service preferences as well as different organisational pathways. ME services required flexibility to accommodate fluctuating demand, but funding arrangements imposed restrictions. The majority of MEs highlighted limited opportunity for formal team contact and a lack of meaningful feedback as limiting scope for development. CONCLUSION: Core components of the ME role were being conducted, although individual and systemic variations in practice were identified. The discussion with bereaved relatives is a unique feature of the ME role and was considered highly valuable, both for the organisation and relatives. Further development could consider the impact of the variation identified and address mechanisms for feedback and shared learning.


Assuntos
Médicos Legistas , Assistência ao Paciente , Inglaterra , Pessoal de Saúde , Humanos , Pesquisa Qualitativa , País de Gales
6.
BMJ Open ; 10(12): e041422, 2020 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-33310804

RESUMO

OBJECTIVES: Emergency departments (EDs) are complex adaptive systems and improving patient flow requires understanding how ED processes work. This study aimed to explore the patient flow process in an ED in Trinidad and Tobago, identifying organisational factors influencing patient flow. METHODS: Multiple qualitative methods, including non-participant observations, observational process mapping and informal conversational interviews were used to explore patient flow. The process maps were generated from the observational process mapping. Thematic analysis was used to analyse the data. SETTING: The study was conducted at a major tertiary level ED in Trinidad and Tobago. PARTICIPANTS: Patient and staff journeys in the ED were directly observed. RESULTS: Six broad categories were identified: (1) ED organisational work processes, (2) ED design and layout, (3) material resources, (4) nursing staff levels, roles, skill mix and use, (5) non-clinical ED staff and (6) external clinical and non-clinical departments. Within each category there were individual factors that appeared to either facilitate or hinder patient flow. Organisational processes such as streaming, front loading of investigations and the transfer process were pre-existing strategies in the ED while staff actions to compensate for limitations with flow were more intuitive. A conceptual framework of factors influencing ED patient flow is also presented. CONCLUSION: The knowledge gained may be used to strengthen the emergency care system in the local context. However, the study findings should be validated in other settings.


Assuntos
Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Região do Caribe , Comunicação , Eficiência Organizacional , Humanos , Trinidad e Tobago
7.
BMJ Qual Saf ; 28(7): 556-563, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30636202

RESUMO

BACKGROUND: An emergency ambulance is not always the appropriate response for emergency medical service patients. Telephone advice aims to resolve low acuity calls over the phone, without sending an ambulance. In England, variation in rates of telephone advice and patient recontact between services raises concerns about inequities in care. To understand this variation, this study aimed to explore operational factors influencing the provision of telephone advice. METHODS: This is a multimethod qualitative study in three emergency medical services in England with different rates of telephone advice and recontact. Non-participant observation (120 hours) involved 20 call handlers and 27 clinicians (eg, paramedics). Interviews were conducted with call handlers, clinicians and clinician managers (n=20). RESULTS: Services varied in their views of the role of telephone advice, selection of their workforce, tasks clinicians were expected and permitted to do, and access to non-ambulance responses. Telephone advice was viewed either as an acceptable approach to managing demand or a way of managing risk. The workforce could be selected for their expertise or their inability to work 'on-the-road'. Some services permitted proactive identification of calls for a lower priority response and provided access to a wider range of response options. The findings aligned with telephone advice rates for each service, particularly explaining why one service had lower rates. CONCLUSION: Some of the variation observed can be explained by operational differences between services and some of it by access to alternative response options in the wider urgent and emergency care system. The findings indicate scope for greater consistency in the delivery of telephone advice to ensure the widest range of options to meet the needs of different populations, regardless of geographical location.


Assuntos
Serviços Médicos de Emergência , Linhas Diretas/normas , Triagem , Inglaterra , Humanos , Observação , Pesquisa Qualitativa
8.
Psychother Res ; 29(3): 403-414, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-29078740

RESUMO

BACKGROUND: It is estimated that between 3% and 15% of patients have a negative experience of psychotherapy, but little is understood about this. AIMS: The aim of this study was to investigate the factors associated with patients' negative therapy experiences. METHOD: The data comprised 185 patient and 304 therapist questionnaires, 20 patient and 20 therapist interviews. Patients reported on an unhelpful or harmful experience of therapy, and therapists on a therapy where they thought the patient they were working with had a poor or harmful experience. These were transcribed and analysed using thematic analysis. RESULTS: There was a Lack of fit between Patient needs, Therapist skills, and Service structures. This could result in Fault Lines, a tension between Safety and containment and Power and control. This tension led to Strain and Poor Engagement, which led to Consequences following the negative therapy experience. CONCLUSIONS: Patients require clear information, choice, involvement in decision-making, explicit contracting and clarity about sessions and progress. Opportunities for patient feedback should be the norm, where the therapist and service are vigilant for signs of deterioration and solutions considered. Clinical and methodological significance of this article: Estimates of "unwanted effects," including long-lasting effects, of psychotherapy have ranged from 3% to 15%. Few empirical studies have been conducted in this area. This study aimed to address this gap and provide clinicians with a model of risk factors for negative therapy effects. The findings of this study indicate the importance of providing patients with a supportive service structure that offers clear information, choice and involvement in decision-making. Explicit contracting at the beginning of therapy and clarity about sessions and progress are also important in managing patient expectations throughout. Opportunities for patient feedback should be provided.


Assuntos
Transtornos Mentais/terapia , Satisfação do Paciente , Avaliação de Processos em Cuidados de Saúde , Relações Profissional-Paciente , Psicoterapia/normas , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
9.
Emerg Med J ; 35(10): 626-637, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30093379

RESUMO

OBJECTIVES: Patient flow and crowding are two major issues in ED service improvement. A substantial amount of literature exists on the interventions to improve patient flow and crowding, making it difficult for policymakers, managers and clinicians to be familiar with all the available literature and identify which interventions are supported by the evidence. This umbrella review provides a comprehensive analysis of the evidence from existing quantitative systematic reviews on the interventions that improve patient flow in EDs. METHODS: An umbrella review of systematic reviews published between 2000 and 2017 was undertaken. Included studies were systematic reviews and meta-analyses of quantitative primary studies assessing an intervention that aimed to improve ED throughput. RESULTS: The search strategy yielded 623 articles of which 13 were included in the umbrella review. The publication dates of the systematic reviews ranged from 2006 to 2016. The 13 systematic reviews evaluated 26 interventions: full capacity protocols, computerised provider order entry, scribes, streaming, fast track and triage. Interventions with similar characteristics were grouped together to produce the following categories: diagnostic services, assessment/short stay units, nurse-directed interventions, physician-directed interventions, administrative/organisational and miscellaneous. The statistical evidence from 14 primary randomised controlled trials (RCTs) was evaluated to determine if correlation or clustering of observations was considered. Only the fast track intervention had moderate evidence to support its use but the RCTs that assessed the intervention did not use statistical tests that considered correlation. CONCLUSIONS: Overall, the evidence supporting the interventions to improve patient flow is weak. Only the fast track intervention had moderate evidence to support its use but correlation/clustering was not taken into consideration in the RCTs examining the intervention. Failure to consider the correlation of the data in the primary studies could result in erroneous conclusions of effectiveness.


Assuntos
Medicina de Emergência/tendências , Melhoria de Qualidade , Fatores de Tempo , Aglomeração , Medicina de Emergência/normas , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Humanos , Revisões Sistemáticas como Assunto
10.
BMC Med Res Methodol ; 17(1): 11, 2017 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-28118817

RESUMO

BACKGROUND: Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context. In this paper we compare multiple methods used in a multi-site, qualitative study that aimed to identify system influences on decision making. METHODS: The study was conducted in three NHS Ambulance Trusts in England and involved researchers from each Trust working alongside academic researchers. Exploratory interviews with key informants e.g. managers (n = 16) and document review provided contextual information. Between October 2012 and July 2013 researchers observed 34 paramedic shifts and ten paramedics provided additional accounts via audio-recorded 'digital diaries' (155 events). Three staff focus groups (total n = 21) and three service user focus groups (total n = 23) explored a range of experiences and perceptions. Data collection and analysis was carried out by academic and ambulance service researchers as well as service users. Workshops were held at each site to elicit feedback on the findings and facilitate prioritisation of issues identified. RESULTS: The use of a multi-method qualitative approach allowed cross-validation of important issues for ambulance service staff and service users. A key factor in successful implementation of the study was establishing good working relationships with academic and ambulance service teams. Enrolling at least one research lead at each site facilitated the recruitment process as well as study progress. Active involvement with the study allowed ambulance service researchers and service users to gain a better understanding of the research process. Feedback workshops allowed stakeholders to discuss and prioritise findings as well as identify new research areas. CONCLUSION: Combining multiple qualitative methods with a collaborative research approach can facilitate exploration of system influences on patient safety in under-researched settings. The paper highlights empirical issues, strengths and limitations for this approach. Feedback workshops were effective for verifying findings and prioritising areas for future intervention and research.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Tomada de Decisões , Serviços Médicos de Emergência/estatística & dados numéricos , Pesquisa Qualitativa , Adolescente , Adulto , Idoso , Pessoal Técnico de Saúde/organização & administração , Ambulâncias/estatística & dados numéricos , Comportamento Cooperativo , Coleta de Dados/métodos , Serviços Médicos de Emergência/organização & administração , Inglaterra , Feminino , Humanos , Comunicação Interdisciplinar , Masculino , Pessoa de Meia-Idade , Adulto Jovem
11.
J Health Serv Res Policy ; 20(1 Suppl): 45-53, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25472989

RESUMO

OBJECTIVES: Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterized by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service to identify areas of risk associated with decisions about patient care. The aim of this study was to explore systemic influences on decision making by paramedics relating to care transitions to identify potential risk factors. METHODS: An exploratory multi-method qualitative study was conducted in three English National Health Service (NHS) Ambulance Service Trusts, focusing on decision making by paramedic and specialist paramedic staff. Researchers observed 57 staff across 34 shifts. Ten staff completed digital diaries and three focus groups were conducted with 21 staff. RESULTS: Nine types of decision were identified, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. Seven overarching systemic influences and risk factors potentially influencing decision making were identified: demand; performance priorities; access to care options; risk tolerance; training and development; communication and feedback and resources. CONCLUSIONS: Use of multiple methods provided a consistent picture of key systemic influences and potential risk factors. The study highlighted the increased complexity of paramedic decisions and multi-level system influences that may exacerbate risk. The findings have implications at the level of individual NHS Ambulance Service Trusts (e.g. ensuring an appropriately skilled workforce to manage diverse patient needs and reduce emergency department conveyance) and at the wider prehospital emergency care system level (e.g. ensuring access to appropriate patient care options as alternatives to the emergency department).


Assuntos
Tomada de Decisões , Auxiliares de Emergência/psicologia , Segurança do Paciente , Transferência de Pacientes/organização & administração , Comunicação , Serviços Médicos de Emergência/organização & administração , Inglaterra , Retroalimentação , Acessibilidade aos Serviços de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Capacitação em Serviço , Pesquisa Qualitativa , Fatores de Risco , Medicina Estatal/organização & administração
12.
Emerg Med J ; 29(4): 327-32, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-21515877

RESUMO

BACKGROUND: The emergency care practitioner (ECP) role in the UK health service involves paramedic and nurse practitioners with advanced training to assess and treat minor illness and injury. Available evidence suggests that the introduction of this role has been advantageous in terms of managing an increased demand for emergency care, but there is little evidence regarding the quality and safety implications of ECP schemes. OBJECTIVES: The objectives were to compare the quality and safety of care provided by ECPs with non-ECP (eg, paramedic, nurse practitioner) care across three different types of emergency care settings: static services (emergency department, walk-in-centre, minor injury unit); ambulance/care home services (mobile); primary care out of hours services. METHODS: A retrospective patient case note review was conducted to compare the quality and safety of care provided by ECPs and non-ECPs across matched sites in three types of emergency care settings. Retrospective assessment of care provided was conducted by experienced clinicians. The study was part of a larger trial evaluating ECP schemes (http://www.controlled-trials.com/ISRCTN22085282). RESULTS: Care provided by ECPs was rated significantly higher than that of non-ECPs across some aspects of care. The differences detected, although statistically significant, are small and may not reflect clinical significance. On other aspects of care, ECPs were rated as equal to their non-ECP counterparts. CONCLUSIONS: As a minimum, care provided should meet the standards of existing service models and the findings from the study suggest that this is true of ECPs regardless of the service they are operational in.


Assuntos
Pessoal Técnico de Saúde/normas , Serviços Médicos de Emergência/normas , Medicina de Emergência/normas , Profissionais de Enfermagem/normas , Qualidade da Assistência à Saúde/normas , Humanos , Estudos Retrospectivos , Segurança , Medicina Estatal , Reino Unido
13.
Emerg Med J ; 29(1): 47-53, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22186262

RESUMO

BACKGROUND: Emergency Care Practitioners (ECPs) are operational in the UK in a variety of emergency and urgent care settings. However, there is little evidence of the effectiveness of ECPs within these different settings. The aim of this study was to evaluate the impact of ECPs on patient pathways and care in different emergency care settings. METHODS: A pragmatic quasi-experimental multi-site community intervention trial comprising five matched pairs of intervention (ECP) and control services (usual care providers): ambulance, care home, minor injury unit, urgent care centre and GP out-of-hours. The main outcome being assessed was patient disposal pathway following the care episode. RESULTS: 5525 patient episodes (n=2363 intervention and n=3162 control) were included in the study. A significantly greater percentage of patients were discharged by ECPs working in mobile settings such as the ambulance service (percentage diff. 36.7%, 95% CI 30.8% to 42.7%) and care home service (36.8%, 26.7% to 46.8%). In static services such as out-of-hours (-17.9%, -30.8% to -42.7%) and urgent care centres (-11.5%, -18.0% to -5.1%), a significantly greater percentage of patients were discharged by usual care providers. CONCLUSIONS: ECPs have a differential impact compared with usual care providers dependent on the operational service settings. Maximal impact occurs when they operate in mobile settings when care is taken to the patient. In these settings ECPs have a broader range of skills than the usual care providers (eg, paramedic), and are targeted to specific clinical groups who can benefit from alternative pathways of care (such as older people who have fallen). Trial Registration No ISRCTN22085282 (Controlled trials.com).


Assuntos
Procedimentos Clínicos/organização & administração , Serviços Médicos de Emergência/organização & administração , Auxiliares de Emergência , Papel Profissional , Humanos , Análise por Pareamento , Alta do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Reino Unido
14.
J Health Serv Res Policy ; 15 Suppl 2: 41-6, 2010 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-20147423

RESUMO

OBJECTIVES: Patients with chronic obstructive pulmonary disease (COPD) have recently been offered severe weather warnings and medication reminders using an automated telephone service and interactive voice recognition technology. Our aim was to explore patients' and health care staffs' perceptions and experiences of the technologies, their contribution to the management of COPD and implementation issues. METHODS: Qualitative semi-structured telephone interviews were undertaken with 18 patients and six staff from five primary care centres in the Bradford area, England. Interview transcripts were thematically analysed. RESULTS: Patients considered the telephone service was an appropriate way to deliver information but there was some variation in perceived usefulness. Many patients praised the service, valuing reassurance and medication reminders, but others were indifferent and even critical. Criticism tended to reflect scepticism over the reliability of weather forecasts information rather than the automated telephone service itself. There was limited impact on the management strategies of patients apart from some patients ordering medication. Primary care staff considered the service a success but some felt that it lacked participation by hard-to-reach groups (non-English speaking, mild COPD patients). Our concerns about the resource implications of successful implementation were also raised. CONCLUSIONS: An automated telephone service was generally acceptable to patients but changes in COPD management were limited, possibly because the patients already had a good understanding of their condition and self-management strategies. Implications for practice include the need for strategies to target hard-to-reach groups which may need more resources.


Assuntos
Atitude do Pessoal de Saúde , Disseminação de Informação/métodos , Satisfação do Paciente , Doença Pulmonar Obstrutiva Crônica , Sistemas de Alerta , Telefone , Tempo (Meteorologia) , Adulto , Idoso , Inglaterra , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/terapia , Pesquisa Qualitativa , Autocuidado
15.
Occup Med (Lond) ; 55(7): 523-7, 2005 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-16141294

RESUMO

AIM: A random sample of general practitioners (GPs), practice nurses (PNs) and practice managers (PMs) in Sheffield and Manchester was recruited into a study to evaluate the perceptions of occupational health (OH) in primary care. METHODS: Qualitative data were collected using focus groups with three groups of primary care sector professionals. Quantitative data were collected nationally from 295 GPs using a postal questionnaire. RESULTS: GPs and PNs had minimal OH training, and 60% of GPs reported constraints in addressing OH matters with patients. The lack of referral routes (63 and 67%, respectively) was also seen as a barrier. OH was regarded as a speciality, and primary care professionals preferred to refer patients with OH problems to specialist centres because they perceived barriers to their dealing with the issues. A total of 74% of GPs surveyed thought that speedier access to secondary care would help them to address OH problems. CONCLUSIONS: This study has identified some of the problems associated with delivering OH through primary care. It also demonstrated a need for greater emphasis on OH education in medical and nurse training, and a need for better advice for GPs, PNs and PMs regarding support services for OH.


Assuntos
Atitude do Pessoal de Saúde , Saúde Ocupacional , Atenção Primária à Saúde/organização & administração , Adulto , Educação Médica Continuada , Inglaterra , Feminino , Grupos Focais , Humanos , Masculino , Profissionais de Enfermagem , Doenças Profissionais/epidemiologia , Doenças Profissionais/prevenção & controle , Administração de Consultório , Médicos de Família , Inquéritos e Questionários
16.
Appl Ergon ; 36(6): 739-48, 2005 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-16122692

RESUMO

This paper provides an overview of findings from the Health and Safety Laboratory investigation into human factors issues surrounding passenger escape and evacuation in the Ladbroke Grove train crash (1999). Drawing upon a range of contextual information the investigation focused upon identifying barriers and delays to evacuation following the incident. Findings highlight a number of important design shortcomings, as well as scope for the enhancement of both passive and active communication systems. The need to take account of passengers' mental models, intuitions and situation awareness when designing communication systems and emergency egress equipment for the railway carriage environment is highlighted.


Assuntos
Acidentes , Desenho de Equipamento , Ferrovias , Gestão da Segurança/métodos , Comunicação , Ergonomia , Reino Unido
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