Papers by Anna Letterstål
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2011
Objective: Quality improvement initiatives in emergency medicine (EM) often suffer from a lack of... more Objective: Quality improvement initiatives in emergency medicine (EM) often suffer from a lack of benchmarking data on the quality of care. The objectives of this study were twofold: 1. To assess the feasibility of collecting benchmarking data from different Swedish emergency departments (EDs) and 2. To evaluate patient throughput times and inflow patterns. Method: We compared patient inflow patterns, total lengths of patient stay (LOS) and times to first physician at six Swedish university hospital EDs in 2009. Study data were retrieved from the hospitals' computerized information systems during single on-site visits to each participating hospital.
Journal of Vascular Surgery, 2008
To determine claudication patients' risk attitude to invasive treatment and whether this treatmen... more To determine claudication patients' risk attitude to invasive treatment and whether this treatment is cost effective. Methods: Quality of life and health state utility status of 50 consecutive patients with severe intermittent claudication was assessed and compared with ankle-brachial pressure index values (ABPI) and results from treadmill tests before and after endovascular or open revascularization. Health utility scores were then calculated and used in a cost-utility analysis. Results: Before surgery, patients were assigned a utility score of 0.51 (EQ-5D index) for their disease, and the standard gamble (SG) and time trade-off (TTO) median scores were 0.88 and 0.70, respectively. Before treatment, a weak correlation (r ؍ 0.43, P < .001) between having a high risk perception of treatment and patients' walking distance were observed, where patients able to walk short distances accepted a higher risk. After treatment, ABI (P ؍ .003) and walking distance P ؍ .002) improved significantly as well the physical components of the quality of life instruments (P < .001). The surgical treatment generated an improvement in quality of life expressed in QALYs equivalent to 0.17. With an estimated survival of 5 years, it adds up to a value of 0.85, corresponding to a sum of 51,000 US$ gained. Conclusions: Patients with severe intermittent claudication are risk-seeking when it comes to surgical treatment and their risk attitude is correlated to their walking ability and quality of life. The incremental QALYs gained by treatment are achieved at a reasonable cost and revascularization appears to be cost effective. ( J Vasc Surg 2008;47:988-94.)
Journal of Vascular Nursing, 2012
The aim of this study was to describe risk attitude and preference for treatment using a proxy me... more The aim of this study was to describe risk attitude and preference for treatment using a proxy measurement of a general population sample hypothetically facing treatment for open repair (OR) of abdominal aortic aneurysm (AAA). In a telephone interview, a standard gamble (SG) and a time trade-off (TTO) question were asked to elicit risk attitude and preference for treatment in a general population sample of 200 persons, stratified in four age groups. When facing the two questions of (1) either live a shorter life without an AAA compared to a longer life with an AAA (TTO) or (2) taking a risk of living with AAA compared to taking the risk with surgical treatment (SG), the oldest age group was neither willing to live a shorter life without AAA, nor willing to take a risk with surgical treatment to the same extent as the younger age groups: age 50-59 (TTO P = 0.03, SG P = &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), age 60-69 (TTO P = 0.01, SG P = &amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001), age 70-79 (TTO P = 0.02, SG P = 0.002). These results suggest that persons in the age groups over 80 years old in the general population sample are more inclined to go on living with an AAA without taking the immediate risk associated with OR as well as the postoperatively impaired health-related quality of life (HRQL). Preference for treatment in different age groups is important to consider during the decision-making process, especially for patients over 80 years old. Patient education about treatment options, specific risks as well as postoperative impairment of HRQL is necessary in this process.
Journal of Clinical Nursing, 2010
The aim was to elucidate patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; lived experien... more The aim was to elucidate patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; lived experience of the care pathway of going through open surgery for abdominal aortic aneurysm. Open surgical treatment has a great impact on patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; health-related quality of life both before and after treatment. The transition from being independent and asymptomatic to dependent on nursing care can be difficult. To facilitate this process and provide high-quality care, patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; needs must be better understood. An exploratory descriptive design was chosen to describe and understand patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; lived experience. Audio-taped interviews were performed three months postoperatively, covering the care pathway before and after surgery. Interviews were analysed with qualitative content analysis. The informants made a transition from becoming aware of the deadly risk associated with abdominal aortic aneurysm to gradually understanding the physical and emotional impact of the surgical procedure during the recovery process. The experience of not understanding fully the risks of undergoing surgery or its consequences on daily life made the informants unprepared for complications and limitations during the recovery period. Many concerns emerged, with a need for more dialogue and opportunities to understand their own care than those provided by the health care staff. To facilitate the transition process, health care staff should consider patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; unpreparedness for the physical and emotional impact that can follow diagnosis and treatment for abdominal aortic aneurysm and recognise the need for dialogue to enhance participation during recovery. Throughout the care pathway, patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; need for information and for opportunities to reflect on bodily and emotional reactions to the diagnosis and treatment of abdominal aortic aneurysm should be recognised by nurses and physicians to support patients getting realistic expectations of the consequences of treatment and facilitate participation in decisions concerning care and medical treatment.
Journal of Advanced Nursing, 2004
This paper reports on a study which aimed to evaluate the effects of structured written preoperat... more This paper reports on a study which aimed to evaluate the effects of structured written preoperative information on patients&amp;amp;amp;amp;amp;amp;amp;amp;#39; postoperative psychological and physical wellbeing after surgery for abdominal aortic aneurysm (AAA). The possible benefits of current booklets written by professionals on postoperative psychological and physical wellbeing in patients with AAA are unknown. Previous studies have shown that preoperative information has a favourable effect on both mood state and physical mobilization. Fifty-two patients admitted for elective repair of AAA were selected consecutively and randomized to receive only verbal (control group), or verbal and written information in booklet form (experimental group). The booklet contained procedural and sensory information about the disease and its treatment. Two questionnaires were used to establish whether the booklet had any effect on perceived health, psychological and physical wellbeing postoperatively. The two groups were similar regarding their perceived health but differed significantly regarding psychological wellbeing pre- and postoperatively. Patients in the experimental group were significantly sadder both pre- and postoperatively compared with those in the control group. Both groups were similar in postoperative physical wellbeing. This group of patients often has asymptomatic disease, with a short interval between diagnosis and major surgery. When patients receive an information booklet during this period, this seems to cause more worries than anticipated. Hence, a more supportive educational programme might benefit this patient group, both pre- and postoperatively.
Australasian Emergency Nursing Journal, 2007
Patient safety is of the utmost importance in health care. The patient safety culture in an insti... more Patient safety is of the utmost importance in health care. The patient safety culture in an institution has great impact on patient safety. To enhance patient safety and to design strategies to reduce medical injuries, there is a current focus on measuring the patient safety culture. The aim of the present study was to describe the patient safety culture in an ED at two different hospitals before and after a Quality improvement (QI) project that was aimed to enhance patient safety.
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Papers by Anna Letterstål