Out-of-hospital Emergency Medical Services (OHEMS) require fast and accurate assessment of patients and efficient clinical judgment in the face of uncertainty and ambiguity. Guidelines and protocols ...can support staff in these situations, but there is significant variability in their use. Therefore, the aim of this study was to increase our understanding of physician decision-making in OHEMS, in particular, to characterize the types of decisions made and to explore potential facilitating and hindering factors.
Qualitative interview study of 21 physicians in a large, publicly-owned and operated OHEMS in Croatia. Data was subjected to an inductive content analysis.
Physicians (mostly young, female, and early in their career), made three decisions (transport, treat, and if yes on either, how) after an initial patient assessment. Decisions were influenced by patient needs, but to a greater extent by factors related to themselves and patients (microsystem), their organization (mesosystem), and the larger health system (macrosystem). This generated a high variability in quality and outcomes. Participants desired support through further training, improved guidelines, formalized feedback, supportive management, and health system process redesign to better coordinate and align care across organizational boundaries.
The three decisions were made complex by contextual factors that largely lay outside physician control at the mesosystem level. However, physicians still took personal responsibility for concerns more suitably addressed at the organizational level. This negatively impacted care quality and staff well-being. If managers instead adopt a learning orientation, the path from novice to expert physician could be more ably supported through organizational demands and practices aligned with real-world practice. Questions remain on how managers can better support the learning needed to improve quality, safety, and physicians' journey from novice to expert.
Povijest studentskog aktivizma pri Medicinskom fakultetu u Rijeci pa time i znanstveno istraživačka aktivnost naših studenata seže od samih začetaka Fakulteta. Danas na Fakultetu djeluju četiri ...studentske udruge koje tokom godine organiziraju pedesetak studentskih projekata. Kruna tih aktivnosti su studentski kongresi koji populariziraju znanost među studentima te ih uče o neraskidivoj vezi znanstvenih istraživanja, akademskog života i medicine. Oni pružaju priliku studentima da učine svoje prve znanstvene korake u svojoj kući, prezentirajući radove i istraživanja pred širokom međunarodnom publikom. Upravo mogućnost upoznavanja i povezivanja budućih kolega i mladih znanstvenika na međunarodnoj razini stvara temelje za njihov osobni razvoj kao i za napredak znanosti. U posljednjih devet godina studenti našeg fakulteta organizirali su devet Kongresa Prehrane i kliničke dijetoterapije, osam Kongresa Neuroznanosti, tri Kongresa Hitne medicine, Kongres biomedicine, dva Kongresa dentalne medicine, dva Kongresa okolišnog zdravlja, Kongres zaštite zdravlja, šest Internih simpozija studenata Medicinskog fakulteta i Fakulteta zdravstvenih studija, tri simpozija, a potom i tri Kongresa Studenti za ljudska prava te su sudjelovali u organizaciji tri Ljetne škole intervencijske radiologije. Kao rezultat toga, veliki broj studenata uključio se u znanstveno istraživačke projekte koje su prezentirali i na kongresima diljem regije. Kroz navedene kongrese, prošlo je na stotine studenata, koji su svojim aktivnim ili pasivnim sudjelovanjem ili pak kao dio organizacijskog odbora time dali svoj mali doprinos znanosti. Veliki broj stranih studenata koji iz godine u godinu dolaze na naše kongrese ukazuje na njihovu kvalitetu i prepoznatljivost te da su postali svojevrsni brend Medicinskog fakulteta i Sveučilišta u Rijeci.
INTRODUCTION AND GOAL Since 2014. a new palliative care system is being introduced in Croatian health care system. Through its implementation it was noticed that one group of patients is continuously ...standing out for the lack of proper care. Those patients were the elderly and sick patients in foster care households. It has been noted that these patients often end up in emergency rooms for various conditions all due to inadequacy of care provided. After the hospital treatment they are most commonly sent back to their foster families. In this paper our goal will be to try to understand how it is possible and allowed for patients to fall through the cracks of our health and social care system. METHODS As a method an unstructured interview was used. Interviews with stakeholders led to reconstruction of the processes and critical points in patient management. RESULTS Specific circumstances in which the problem occurs were determined and key elements of care recognized. General stance towards this group of patients shows significant signs of inequality in health care. Results show that the problem is systemic and mainly stems from the lack of regulation and understanding in relations between stakeholders. CONCLUSION The problem is significant and has a major impact on patient wellbeing as well as having a great effect on day-to-day work of health institutions. Due to complexity of the situation and high number of stakeholders involved we can conclude that more attention should be given, and more resources diverted to the concept of integrated care.
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