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Elfström, Johan
Alternative names
Publications (8 of 8) Show all publications
Öhrn, A., Ericsson, C., Andersson, C. & Elfström, J. (2018). High Rate of Implementation of Proposed Actions for Improvement With the Healthcare Failure Mode Effect Analysis Method: Evaluation of 117 Analyses. Journal of patient safety, 14(1), 17-20
Open this publication in new window or tab >>High Rate of Implementation of Proposed Actions for Improvement With the Healthcare Failure Mode Effect Analysis Method: Evaluation of 117 Analyses
2018 (English)In: Journal of patient safety, ISSN 1549-8417, E-ISSN 1549-8425, Vol. 14, no 1, p. 17-20Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: The aims of this study were to investigate what kind of impact the Healthcare Failure Mode Effect Analysis (HFMEA) had on the organization in 1 county council in Sweden and to evaluate the method of working for multidisciplinary teams performing HFMEA. Three main outcome measures were used: the quality of the documentation from the HFMEAs, fulfillment of the primary goal of the HFMEA, and, finally, whether proposed actions for improvement were implemented.

METHODS: The study involved retrospective analysis of the documentation from 117 performed HFMEAs from 3 hospitals in the county council of Östergötland, Sweden, and interviews or questionnaires with team leaders and managers between 2006 and 2010.

RESULTS: A proposed change in the organizational structure was the most common issue in the analyses. Eighty-nine percent of the written reports were of high quality. A median of 10 serious risks were detected, and 10 proposed actions (median) were made. In 78% of the HFMEAs, all or a large part of these had been implemented a few years afterward. We were unable to find factors that promoted the rate of implementation of proposed actions. Seventy-eight percent of the managers were completely satisfied with the results of the HFMEA. The mean cost per risk analysis was &OV0556;1909.

CONCLUSIONS: Most of the proposed actions were implemented. The use of HFMEA can be improved using fewer team leaders but with more experience. The work involved in writing a report can be reduced without loss of impact on the organization.This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
Keywords
HFMEA, evaluation, implementation, patient safety
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-126074 (URN)10.1097/PTS.0000000000000159 (DOI)000426551800006 ()25719818 (PubMedID)
Available from: 2016-03-23 Created: 2016-03-14 Last updated: 2018-04-11
Öhrn, A., Elfström, J., Tropp, H. & Rutberg, H. (2012). What can we learn from patient claims?: Analysing of patient injuries following orthopaedic surgery. Patient Safety in Surgery, 6(2), 1-6
Open this publication in new window or tab >>What can we learn from patient claims?: Analysing of patient injuries following orthopaedic surgery
2012 (English)In: Patient Safety in Surgery, ISSN 1754-9493, Vol. 6, no 2, p. 1-6Article in journal (Refereed) Published
Abstract [en]

Background: Objective data on the incidence and pattern of adverse events after orthopaedic surgical procedures remain scarce, secondary to the reluctance for encompassing reporting of surgical complications. The aim of this study was to analyze the nature of adverse events after orthopaedic surgery reported to a national database for patient claims in Sweden.

Methods: In this retrospective review data from two Swedish national databases during a 4-year period were analyzed. We used the "County Councils' Mutual Insurance Company", a national no-fault insurance system for patient claims, and the "National Patient Register at the National Board of Health and Welfare".

Results: A total of 6,029 patient claims filed after orthopaedic surgery were assessed during the study period. Of those, 3,336 (55%) were determined to be adverse events, which received financial compensation. Hospital-acquired infections and sepsis were the most common causes of adverse events (n = 741; 22%). The surgical procedure that caused the highest rate of adverse events was "decompression of spinal cord and nerve roots" (code ABC**), with 168 adverse events of 17,507 hospitals discharges (1%). One in five (36 of 168; 21.4%) injured patient was seriously disabled or died.

Conclusions: We conclude that patients undergoing spinal surgery run the highest risk of being severely injured and that these patients also experienced a high degree of serious disability. The most common adverse event was related to hospital acquired infections. Claims data obtained in a no-fault system have a high potential for identifying adverse events and learning from them.

Keywords
Insurance Claim Review, Medical Errors, Orthopaedics, Patient Safety, Patient Admission, Safety Management
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72590 (URN)10.1186/1754-9493-6-2 (DOI)
Note

On the day of the defence date the status of this article was "Manuscript".

Available from: 2011-11-29 Created: 2011-11-29 Last updated: 2014-09-11Bibliographically approved
Öhrn, A., Elfström, J., Liedgren, C. & Rutberg, H. (2011). Reporting of Sentinel Events in Swedish Hospitals: A Comparison of Severe Adverse Events Reported by Patients and Providers. Joint Commission Journal on Quality and Patient Safety, 37(11), 495-501
Open this publication in new window or tab >>Reporting of Sentinel Events in Swedish Hospitals: A Comparison of Severe Adverse Events Reported by Patients and Providers
2011 (English)In: Joint Commission Journal on Quality and Patient Safety, ISSN 1553-7250, E-ISSN 1938-131X, Vol. 37, no 11, p. 495-501Article in journal (Refereed) Published
Abstract [en]

Background: Mandatory and voluntary reporting of adverse events is common in health care organizations but a more accurate understanding of the extent of patient injury may be obtained if additional sources are used. Patients in Sweden may file a claim for economic compensation from the national insurance system if they believe they have sustained an injury. The extent and pattern of reporting of serious adverse events in a mandatory national reporting system was compared with the reporting of adverse events on the basis of patient claims.

Methods: Regional sentinel event reports were compared with malpractice claims data between 1996 and 2003. A sample consisting of 113 patients with deaths or serious injuries was selected from the malpractice claims data source. The medical records of these patients were reviewed by three chief medical officers.

Results: Of the deaths or injuries associated with the 113 patients—25 deaths, 37 with more than 30% disability, and 51 with 16%-30% disability—23 (20%) had been reported by chief medical officers to the National Board of Health and Welfare as sentinel events. Most adverse events were found in orthopedic surgery, and orthopedic injuries had more serious consequences. None of the patient injuries caused by infections were reported as sentinel events. Individual errors were more frequent in cases reported as sentinel events.

Conclusions: Adverse events causing severe harm are underreported to a great extent in Sweden despite the existence of a mandatory reporting system; physicians often consider them to be complications. Health care organizations should consider using a portfolio of tools—including incident reporting, medical record review, and analysis of patient claims—to gain a comprehensive picture of adverse events.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-72589 (URN)
Available from: 2011-11-29 Created: 2011-11-29 Last updated: 2017-12-08Bibliographically approved
Elfstrom, J., Nilsson, L. & Sturnegk, C. (2009). Sjukvårdens händelse-analyser bör skärpas och involvera läkare. Läkartidningen, 106(48), 3262-3267
Open this publication in new window or tab >>Sjukvårdens händelse-analyser bör skärpas och involvera läkare
2009 (English)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 48, p. 3262-3267Article in journal (Refereed) Published
Abstract [en]

[No abstract available]

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-52961 (URN)
Available from: 2010-01-14 Created: 2010-01-14 Last updated: 2017-12-12
Öhrn, A., Andersson, C., Elfström, J., Liedgren, C. & Rutberg, H. (2007). Framgång kräver ledningens stöd och resurser. Läkartidningen, 104(4), 224-228
Open this publication in new window or tab >>Framgång kräver ledningens stöd och resurser
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2007 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 4, p. 224-228Article in journal (Other academic) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-50673 (URN)
Available from: 2009-10-13 Created: 2009-10-13 Last updated: 2017-12-12
Öhrn, A., Tropp, H., Scheer, J., Horn, B., Rutberg, H. & Elfström, J. (2006). Flest vårdskador inom ortopedi, visar Patientförsäkringen. Skadepanorama och vårdkonsumtion för denna patientgrupp har klartlagts.. Läkartidningen, 103, 534-539
Open this publication in new window or tab >>Flest vårdskador inom ortopedi, visar Patientförsäkringen. Skadepanorama och vårdkonsumtion för denna patientgrupp har klartlagts.
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2006 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, p. 534-539Article in journal (Other academic) Published
Abstract [sv]

   

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-40514 (URN)53434 (Local ID)53434 (Archive number)53434 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
Berglund, J., Björck, M. & Elfström, J. (2005). Long-term results of above knee femoro-popliteal bypass depend on indication for surgery and graft-material. European Journal of Vascular and Endovascular Surgery, 29(4), 412-418
Open this publication in new window or tab >>Long-term results of above knee femoro-popliteal bypass depend on indication for surgery and graft-material
2005 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 29, no 4, p. 412-418Article in journal (Refereed) Published
Abstract [en]

Objective. To determine the long-term results of above-knee femoro-popliteal bypass with autologous saphenous vein (SV) or expanded polytetrafluoroethylene (ePTFE) in routine surgical practice. Methods. Data from the Swedish vascular registry, Swedvasc was reviewed retrospectively. Patients with bypass surgery in 1996 and 1997 were assessed 5-7 years later. Data were gathered from the case-records and from clinical follow-up. The composite endpoint of graft failure included death within 30 days, occlusion, major amputation, extension of the graft to below-knee position and removal of an infected graft. Kaplan-Meier curves and Cox' proportional hazard ratios were calculated. Results. Four hundred and ninety-nine patients undergoing bypass for critical limb ischemia (CLI) (56%) or claudication (44%), SV (28%) or ePTFE (72%), were included. There were no significant differences in patient characteristics between patients with SV or ePTFE. CLI and ePTFE were risk factors for graft failure. For patients with both claudication and CLI SV grafts yielded better long-term results than ePTFE grafts (p<0.03) and (p<0.003), respectively. Symptom aggravation after graft occlusion was almost exclusively restricted to ePTFE grafts. Conclusions. Femoro-popliteal bypass above-knee with SV gives good long-term results, especially for claudication. ePTFE grafts cannot be recommended in claudicants, since occlusion occurs often and frequently leads to CLI. © 2005 Elsevier Ltd. All rights reserved.

Keywords
popliteal artery, intermittent claudication, critical ischemia, blood vessel prosthesis implantation, surgery operative
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28734 (URN)10.1016/j.ejvs.2004.12.023 (DOI)13906 (Local ID)13906 (Archive number)13906 (OAI)
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2017-12-13
Ajari, A., Bergqvist, D., Elfström, J., Örtenvall, P., Troeng, T., Hedberg, B., . . . Norgren, L. (1999). Diabetes mellitus as a risk factor for early outcome after carotid endarterectomy - a population study.. European Journal of Vascular and Endovascular Surgery, 18, 122-126
Open this publication in new window or tab >>Diabetes mellitus as a risk factor for early outcome after carotid endarterectomy - a population study.
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1999 (English)In: European Journal of Vascular and Endovascular Surgery, ISSN 1078-5884, E-ISSN 1532-2165, Vol. 18, p. 122-126Article in journal (Refereed) Published
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28128 (URN)12939 (Local ID)12939 (Archive number)12939 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13
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