Table 1 Examples of the analysis of the observations
Unit of meaning | Codes | Categories | Theme |
|---|---|---|---|
The CN talks with the medical DOC, who says that medical patients have to wait for a long time. He ascertains that the level of activity is 2 according to the ‘Plan for High Activity’. The CN adds that it is quite full on the medical wards, but some beds are available on surgical wards. I think we have level 2 to 3. | Information on patient occupancy | Deciding activity level | 1.Receiving an overview of the team and the patients and planning the shift |
The DOC informs the CN that he is going to reallocate the medical doctors in the treatment section so that the patient followed by the police is quickly seen by a doctor. | Allocating doctors | Reallocating staff | 2. Ensuring resources |
The DOC tells the CN about two patients who can be transferred to the medical ward and a patient that can be discharged. In this regard he adds the following comment: “It is all about if we can have some advantages by ‘turning’ (early discharging) patients. | Providing patient discharge and patient transfer to medical units | Patient transfer | 3. Monitoring and ensuring patient flow |
The CN receives a call from the AMCC regarding a fire in a house downtown. The CN informs the DOC that doctors and anesthesiologists must not leave work. She tells the nurses and doctors in the treatment section to move all patients to units. She also informs a nurse to call for more nurses and the surgical DOC to empty the triage. | Instructing the staff to not leave work and transfer all patients to hospital units | Instructing in accordance with guidelines | 4. Monitoring and securing information flow |
The CN receives a fax from the AMCC about a patient with a cerebral injury. She calls the neurologist, asking if preparation should be made for actilysis treatment, CT scanning, and blood samples. She tells the nurse that a possible new actilysis patient will be placed in B3. The CN calls the radiology department and orders a CT scan and blood tests. | Activating the patient’s treatment team | Coordinating care | 5. Securing patient care and treatment |
The DOC and the medical student review the patient’s medical record, diagnosis and treatment. Further, the DOC guides the student regarding what to do and why and asks her to identify the relationships between symptoms and tests, further encouraging the student to consider this while he is looking at the ECG. Additionally, the DOC summarizes the patient’s health problems and identifies a future treatment plan. A little later, the DOC checks the patient’s medical record and then signs it. | Guiding and monitoring peers in diagnosis and treatment of patients | Supervising peers | 6. Securing and assuring the quality of diagnosis and treatment of patients |
The DOC tells the CN that the patient with high CRP must be prioritized into the treatment section. The DOC asks the junior doctor to have a look at the patient. The DOC looks at the medical record and examines the patient and then talks with a junior doctor about the patient’s diagnosis. The DOC tells the junior doctor to prioritize this patient. | Care of the patient | Seeing the patient | 7. Securing the priority of patients |