Use of the Hospital Survey of Patient Safety Culture in Norwegian Hospitals: A Systematic Review

This review aims to provide an overview of empirical studies using the HSOPSC in Norway and to develop recommendations for further research on patient safety culture. Oria, an online catalogue of scientific databases, was searched for patient safety culture in February 2021. In addition, three articles were identified via Google Scholar searches. Out of 113 retrieved articles, a total of 20 articles were included in our review. These were divided into three categories: seven perception studies, six intervention studies, and seven reliability and validation studies. The first study conducted in Norway indicated a need to improve patient safety culture. Only one intervention study was able to substantially improve patient safety culture. The validity of HSOPSC is supported in most studies. However, one study indicated poor quality in relation to the testing of criteria related to validity. This review is limited to Norwegian healthcare but has several relevant implications across the research field, namely that intervention studies should (1) validate dimensions more carefully, (2) avoid pitfalls related to both factor analysis methods and criteria validity testing, (3) consider integrating structural models into multilevel improvement programs, and (4) benefit from applying different, new versions of HSOPSC developed in Norway.publishedVersio

Qualitative research as reflexive process: a word limitation challenge in qualitative medical research publications?

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Pasienterfaringer etter dagkirurgi – oversettelse og validering av spørreskjemaet Quality of Recovery-15 (QoR-15nor)

Samfunnsutviklingen medfører økt etterspørsel etter helsetjenester, noe som øker presset på sykehusene. Som en respons på dette gjennomføres en økende andel kirurgiske inngrep dagkirurgisk. Pasienterfaringer sidestilles med andre kvalitetsparametre for helsetjenestekvalitet, som for eksempel infeksjonsforekomst eller liggetid. Kunnskapssenteret har utarbeidet et spørreskjema med 24 spørsmål som fokuserer på pasienterfaringer etter dagkirurgi. Dette skjemaet kartlegger pasientens erfaringer, men i mindre grad pasientrapporterte postoperative symptomer. Spørreskjemaet Quality of Recovery-15 (QoR-15) er et internasjonalt anerkjent spørreskjema som kan benyttes som verktøy for å kartlegge pasienters symptomer etter et dagkirurgisk inngrep. Skjemaet er ikke oversatt og validert på norsk.publishedVersio

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

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.publishedVersio

Nurse competence in the interface between primary- and tertiary healthcare

Aims (a) To explore nurses’ self‐assessed competence and perceived need for more training in primary and tertiary healthcare services; and (b) to investigate the factors associated with these issues. Design Quantitative, cross‐sectional, descriptive. Methods The ProffNurseSAS, the Job Satisfaction Scale and socio‐demographics were used. A convenient sampling method was used to invite registered nurses from 23 primary (N = 104) and tertiary care wards (N = 26). Results Five significant differences in self‐assessed competence were identified, with none regarding the perceived need for more training between nurses working in primary versus tertiary health care. Nurses in primary health care had longer experience, and a larger proportion had continuing education. Nevertheless, this was not associated with either self‐assessed competence or the perceived need for more training. Years of experience, training or reported job satisfaction was not associated with the items on the ProffNurseSAS. Conclusion Findings indicate that nurses’ competence is same in primary and tertiary healthcare settings. Moreover, the findings of this research highlight areas that need further improvement and emphasis from both leaders and educational institutions when they attempt to ensure nurses’ competence.publishedVersio

Efficacy of a TAP block versus an anterior QLB for laparoscopic inguinal hernia repair: A randomised controlled trial

Background Both the transversus abdominis plane (TAP) block and the anterior quadratus lumborum block (QLB) have been shown effective in reducing postoperative pain after laparoscopic inguinal hernia repair. Our hypothesis was that there is no difference in analgesic effect between the two blocks for this procedure. Methods In this prospective, double-blind, randomised controlled study, 60 adult patients undergoing laparoscopic inguinal hernia repair were equally randomly assigned to either a preoperative TAP block or an anterior QLB. The primary outcome was oral morphine equivalent (OME) consumption at 4 h postoperatively. Secondary outcomes were OME consumption at 24, 48 h and 7 days, pain scores at rest and when coughing, nausea, and level of sedation measured at 1, 2, 3, 24, and 48 h and 7 days postoperatively. Results Fifty-three patients completed the study. There was no significant difference in OME consumption at 4 h postoperatively, TAP group (10.3 ± 7.85 mg) (mean ± SD) versus the anterior QLB group (10.9 ± 10.85 mg) (p = .713). The pain scores were similar at rest and when coughing during the 7 day observation period, as were the level of sedation and incidence of nausea. There were no cases of serious side-effects or muscle weakness of the thigh on the same side as the block. Conclusion There is no difference in OME consumption, pain, nausea or sedation between the TAP and the anterior QLB. Thus, the choice between the two blocks in a clinical setting of laparoscopic inguinal hernia repair should be based on other aspects, such as skills, practicalities, and potential risks.publishedVersio

Prehospital assessment and management of postpartum haemorrhage– healthcare personnel’s experiences and perspectives

Background Postpartum hemorrhage (PPH) is a serious obstetric emergency, and one of the top five causes of maternal mortality globally. The most common causes of PPH include uterine atony, placental disorders, birth trauma and coagulation defects. Timely diagnosis and early management are critical to reduce morbidity, the need for blood transfusion or even mortality. External, manual aortic compression (AC) has been suggested as an intervention that reduce PPH and extend time for control of bleeding or resuscitation. This procedure is not commonly utilized by healthcare personnel. The incidence of home-births is increasing, and competence in PPH assessment and management is essential in prehospital personnel. The objective was to explore prehospital personnel’s competence in PPH and AC, utilizing different tools. Methods The study was conducted in a county in South-eastern Norway, including five ambulance stations. All prehospital personnel (n = 250) were invited to participate in a questionnaire study. The questionnaire included the PPH self-efficacy (PPHSE) and PPH collective efficacy (PPHCE) tools, as well as tool developed utilizing the Delphi technique. Descriptive statistics were used to analyze the quantitative data, while quantitative content analysis was used to analyse free-text responses. Results A total of 87 prehospital personnel responded to the questionnaire, 57.5% male, mean age 37.9 years. In total, 80.4% were ambulance workers and/or paramedics, and 96.6 and 97.7% respectively reported to need more education or training in PPH. Moreover, 82.8% reported having managed patient(s) with PPH, but only 2.9% had performed AC. Prehospital personnels’ responses varied extensively regarding knowledge about what PPH is, how to estimate and handle PPH, and how to perform AC. Mean self-efficacy varied from 3.3 to 5.6, while collective efficacy varied from 1.9 to 3.8. Conclusions This study indicates that prehospital personnel lack knowledge about PPH and AC, due to various responses to the developed questionnaire. Even though AC is an acknowledged intervention in PPH, few participants reported that this was utilized. Our findings emphasize the need for education and training in PPH and PPH handling generally, and in AC specifically.publishedVersio

Patient experiences and predictors in an acute geriatric ward: a cross-sectional study

Aims and objectives To investigate older peoples’ experiences with acute hospital treatment and care, and variables that may influence these experiences. Background In the Nordic countries, research on older peoples’ experiences with hospital care is sparse. Methods Participants were recruited from an acute geriatric ward in a hospital in Norway during a 1‐year period (n = 189). Patient experience was assessed using the Picker Patient Experience Questionnaire, self‐rated health by Euro‐QoL 5‐dimension, three‐level version and comorbidity by Charlson comorbidity index. Results Responders’ median age was 79 years, 48.7% male. Most of the problems were related to continuity and transition, while fewest problems were related to respect for patient preferences. Charlson comorbidity index score and the variables “still working,” “in a relationship” and “living alone” negatively influenced patient experience. Conclusions A high amount of problems were identified among patients hospitalised in an acute geriatric ward. Findings from this study may provide important information about issues that need focus to increase the care experiences of older people. Relevance to clinical practice Results from this study adds to existing knowledge, and emphasize the need for increased focus on discharge and continuity of care processes.acceptedVersio

The aftermath of surviving a sudden cardiac arrest for young exercisers- a qualitative study in Norway

Background: When surviving a sudden cardiac arrest (SCA), physical, cognitive, and emotional efects of surviving may be present for months or years. The survivors’ family and colleagues are also highly afected by the incident. There is little knowledge about experiences of surviving SCA in individuals who prior to the incident were young and reported to exercise regularly. Consequently, the aim of this study was to explore the aftermath of surviving a SCA in young, regular exercisers. Methods: The study had a qualitative design, conducting in-depth individual interviews with SCA survivors<50 years of age reporting to exercise≥5 h/week and/or who sufered SCA during or less than 60 min after exercise. The data were analysed using systematic text condensation in-line with recommendations from Malterud. Results: 18 of 31 eligible participants were included in the study. Through analysis we identifed ‘Establishing a new everyday life’ as superordinate category, with subordinate categories a) being part of my surroundings, b) expecting normality but facing a new reality and c) lucky to be alive! Conclusion: This study adds knowledge about young and regular exercisers’ experiences after surviving a SCA. The obligations of everyday life in young survivors of SCA often imply a high work load and complex tasks, e.g. due to being in the beginning of their career or even still studying. Healthcare personnel, as well as the society, need to acknowledge that although lucky to be alive and apparently well-functioning, young survivors of SCA may have per‑sistent challenges that cause frustration and reduced quality of life.publishedVersio

Spread of local anesthetics after erector spinae plane block: an MRI study in healthy volunteers

Background Erector spinae plane block (ESPB) is a truncal fascial block with a disputed mechanism and anatomical site of effect. This study aimed to perform a one-sided ESPB and use MRI to investigate the spread of the local anesthetic (LA) and the corresponding cutaneous loss of sensation to pinprick and cold. Methods Ten volunteers received a right-sided ESPB at the level of the seventh thoracic vertebra (Th7), consisting of 30 mL 2.5 mg/mL ropivacaine with 0.3 mL gadolinium. The primary outcome was the evaluation of the spread of LA on MRI 1-hour postblock. The secondary outcome was the loss of sensation to cold and pinprick 30–50 min after the block was performed. Results All volunteers had a spread of LA on MRI in the erector spinae muscles and to the intercostal space. 9/10 had spread to the paravertebral space and 8/10 had spread to the neural foramina. 4/10 volunteers had spread to the epidural space. One volunteer had extensive epidural spread as well as contralateral epidural and foraminal spread. Four volunteers had a loss of sensation both posterior and anterior to the midaxillary line, while six volunteers had a loss of sensation only on the posterior side. Conclusion We found that LA consistently spreads to the intercostal space, the paravertebral space, and the neural foramina after an ESPB. Epidural spread was evident in four volunteers. Sensory testing 30–50 min after an ESPB shows highly variable results, and generally under-represents what could be expected from the visualized spread on MRI 60 min after block performance. Trial registration number NCT05012332.publishedVersio