Organisational factors underpinning intra-hospital transfers: a guide for evaluating context in quality improvement.

IF 1.2 Q4 HEALTH POLICY & SERVICES Health Systems Pub Date : 2020-05-27 eCollection Date: 2021-01-01 DOI:10.1080/20476965.2020.1768807
Renee Fekieta, Alana Rosenberg, Beth Hodshon, Shelli Feder, Sarwat I Chaudhry, Beth L Emerson
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引用次数: 3

Abstract

During intra-hospital transfers, multiple clinicians perform coordinated tasks that leave patients vulnerable to undesirable outcomes. Communication has been established as a challenge to care transitions, but less is known about the organisational complexities within which transfers take place. We performed a qualitative assessment that included various professions to capture a multi-faceted understanding of intra-hospital transfers. Ethnographic observations and semi-structured interviews were conducted with clinicians and staff from the Medical Intensive Care Unit, Emergency Department, and general medicine units at a large, urban, academic, tertiary medical centre. Results highlight the organisational factors that stakeholders view as important for successful transfers: the development, dissemination, and application of protocols; robustness of technology; degree of teamwork; hospital capacity; and the ways in which competing hospital priorities are managed. These factors broaden our understanding of the organisational context of intra-hospital transfers and informed the development of a practical guide that can be used prior to embarking on quality improvement efforts around transitions of care.

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支持医院内转诊的组织因素:质量改进环境评价指南。
在医院内转院期间,多名临床医生执行协调的任务,使患者容易受到不良后果的影响。沟通已被确立为护理转移的挑战,但对转移发生的组织复杂性知之甚少。我们进行了一项定性评估,包括不同的专业,以获得对院内转院的多方面理解。在一个大型的城市三级学术医疗中心,对来自医疗重症监护室、急诊科和普通医学单位的临床医生和工作人员进行了人种学观察和半结构化访谈。结果突出了利益相关者认为对成功转移至关重要的组织因素:协议的制定、传播和应用;技术的稳健性;团队合作程度;医院的能力;以及医院优先级竞争的管理方式。这些因素拓宽了我们对院内转院的组织背景的理解,并为制定实用指南提供了依据,该指南可在围绕转院开展质量改进工作之前使用。
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来源期刊
Health Systems
Health Systems HEALTH POLICY & SERVICES-
CiteScore
4.20
自引率
11.10%
发文量
20
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