title: Patients' experiences of postoperative intermediate care and standard surgical ward care after emergency abdominal surgery: a qualitative sub-study of the Incare trial.
abstract: OBJECTIVE
  To elicit knowledge of patient experiences of postoperative intermediate care in an intensive care unit and standard postoperative care in a surgical ward after emergency abdominal surgery.
  
  
  BACKGROUND
  Emergency abdominal surgery is common, but little is known about how patients experience postoperative care. The patient population is generally older with multiple comorbidities, and the short-term postoperative mortality rate is 15-20%. Thus, vigilant surgeon and nursing attention is essential. The present study is a qualitative sub-study of a randomised trial evaluating postoperative intermediate care after emergency abdominal surgery, the InCare trial.
  
  
  METHODS
  A qualitative study with individual semi-structured interviews.
  
  
  METHODS
  We analysed interviews using Systematic Text Condensation.
  
  
  RESULTS
  Eighteen patients (nine intervention/nine controls) were strategically sampled from the InCare trial. Data analysis resulted in three distinct descriptions of intermediate care; two of standard surgical ward care. Intermediate care was described as 'luxury service' or 'a life saver.' The latter description was prevalent among patients with a perceived complicated disease course. Intermediate care patients felt constrained by continuous monitoring of vital signs as they recovered from surgery. Standard surgical ward care was described as either 'ok - no more, no less' or 'suboptimal'. Experiencing suboptimal care was related to patient perceptions of heavy staff workloads, lack of staff availability and subsequent concerns about the quality of care.
  
  
  CONCLUSIONS
  Postoperative intermediate care enhanced perceptions of quality of care, specifically in patients with a perceived complicated disease course. Patients were eager to contribute actively to their recovery; however, intermediate care patients felt hindered in doing so by continuous monitoring of vital signs.
  
  
  CONCLUSIONS
  Intermediate care may increase patient perceptions of quality and safety of care.
authors.affiliation: Abdominal Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Thordis
authors.initials: T
authors.lastname: Thomsen
authors.forename: Morten
authors.initials: M
authors.lastname: Vester-Andersen
authors.forename: Martin Vedel
authors.initials: MV
authors.lastname: Nielsen
authors.forename: Tina
authors.initials: T
authors.lastname: Waldau
authors.forename: Ann Merete
authors.initials: AM
authors.lastname: Møller
authors.forename: Jacob
authors.initials: J
authors.lastname: Rosenberg
authors.forename: Morten Hylander
authors.initials: MH
authors.lastname: Møller
authors.forename: Kristin Brønnum
authors.initials: KB
authors.lastname: Nystrup
authors.forename: Bente Appel
authors.initials: BA
authors.lastname: Esbensen
mesh_terms: D000005:Abdomen / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D005260:Female; D066297:Hermeneutics; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods*; D011184:Postoperative Period; D011997:Recovery Room
keywords: emergency abdominal surgery; patient experiences; postoperative intermediate care; postoperative surgical ward care; quality and safety of care