Centre for Health and Social Care Studies, University of Sheffield, Samuel Fox House, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
Emerg Med J. 2010 Sep;27(9):672-6. doi: 10.1136/emj.2009.073908. Epub 2010 Jun 1.
The ESCAPE trial was a multicentre randomised controlled trial investigating the effectiveness of Chest Pain Unit (CPU) care. The process of CPU implementation and the activity of individual CPUs varied substantially between hospitals. The study reported here explored the organisational factors that influenced this variation.
A multiple case study approach was taken treating each site as a 'case'. Six intervention sites were studied. Qualitative data were collected through interviews with key personnel at each site.
Activity of individual CPUs was not adequately explained by simple structural differences between hospitals, such as their size or location, or between CPUs, such as staffing and hours. Analysis suggested that the more active CPUs tended to have more of the following characteristics: being 'primed' by previous initiative or experience; appropriate leadership; a positive climate for innovation; established relationships between key staff/departments; role clarity amongst staff; an enthusiast for the development; and continuity of staffing. Role conflict, particularly between specialist nurses and others, was reported and had potential to interfere with development.
Organisational factors were identified that could have impacted on the outcomes of the ESCAPE trial through, for example, delays in discharge, and missed recruitment opportunities. Complex interventions such as the ESCAPE trial are prone to the effects of local organisational issues, some of which could be predicted and planned for. Findings from single centre studies of complex interventions should be treated with caution before a decision is taken to implement in a new setting.
ESCPE 试验是一项多中心随机对照试验，旨在研究胸痛单元 (CPU) 护理的有效性。CPU 的实施过程和各个 CPU 的活动在医院之间存在很大差异。本研究探讨了影响这种差异的组织因素。
采用多案例研究方法，将每个站点视为一个“案例”。研究了六个干预站点。通过对每个站点的关键人员进行访谈收集定性数据。
单个 CPU 的活动不能仅通过医院之间的简单结构差异（如规模或位置）或 CPU 之间的差异（如人员配备和工作时间）来充分解释。分析表明，活动较多的 CPU 往往具有以下特征：之前有过主动或经验；有适当的领导；创新的积极氛围；关键人员/部门之间建立了关系；工作人员之间的角色明确；热衷于发展；以及人员配置的连续性。报告了角色冲突，特别是在专科护士和其他人之间，这可能会干扰发展。
确定了一些组织因素，这些因素可能通过延迟出院和错失招募机会等方式影响 ESCAPE 试验的结果。复杂干预措施（如 ESCAPE 试验）容易受到当地组织问题的影响，其中一些问题可以预测并进行规划。在决定在新环境中实施之前，应谨慎对待针对复杂干预措施的单中心研究结果。
