1Division of Critical Care, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada. 2The Academy for Innovation in Medical Education (AIME), Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. 3Practice, Performance and Innovation (PPI) Unit, The Royal College of Physicians and Surgeons of Canada (RCPSC), Ottawa, ON, Canada. 4School of Nursing, The University of Ottawa, Ottawa, ON, Canada. 5University of Ottawa Skills and Simulation Centre (uOSSC), Ottawa, ON, Canada.
Crit Care Med. 2014 Apr;42(4):831-40. doi: 10.1097/CCM.0000000000000036.
To design and implement a needs assessment process that identifies gaps in caring for critically ill patients in a community hospital.
DESIGN, SETTING, SUBJECTS: This mixed-method study was conducted between June 2011 and February 2012. A conceptual framework, centered on the critically ill patient, guided the design and selection of the data collection instruments. Different perspectives sampled included regional leaders, healthcare professionals at the community hospital and its referral hospital, as well as family members of patients who had received care at the community ICU. Data sources included interviews (n = 22), walk-throughs (n = 5), focus groups (n = 31), database searches, context questionnaires (n = 8), family surveys (n = 16), and simulations (n = 13).
None.
Nine needs were identified. At the community hospital, needs identified included lack of access to human resources, gaps in expertise, poor patient flow and ICU bed use, communication, lack of educational opportunities, and gaps in end-of-life care and interprofessional teamwork. Needs were also identified in the interhospital interaction between the community and referral hospitals, which included an inadequate hospital network and gaps in transfer and repatriation of patients. The methodology uncovered the causes and widespread impact of each need and how they interacted with one another. Proposed solutions by the participants are presented including both organizational and educational/clinical solutions.
This study captured needs in a complex, interprofessional, interhospital context, which can be targeted with tailored interventions to improve patient outcomes in a community hospital. Furthermore, this study provides a preliminary framework and rigorous methodology to performing a needs assessment in this setting.
设计并实施一项需求评估流程，以确定社区医院中危重症患者护理方面的差距。
设计、地点、研究对象：本混合方法研究于 2011 年 6 月至 2012 年 2 月进行。一个以危重症患者为中心的概念框架指导了设计和数据收集工具的选择。从不同角度进行了抽样，包括区域领导、社区医院及其转诊医院的医疗保健专业人员，以及在社区 ICU 接受过治疗的患者的家属。数据来源包括访谈（n=22）、现场考察（n=5）、焦点小组（n=31）、数据库搜索、情境问卷（n=8）、家庭调查（n=16）和模拟（n=13）。
无。
确定了 9 个需求。在社区医院，确定的需求包括人力资源获取困难、专业知识差距、患者流动和 ICU 床位使用不佳、沟通不畅、缺乏教育机会以及临终关怀和跨专业团队合作差距。在社区和转诊医院之间的医院间互动中也确定了需求，包括医院网络不足以及患者转院和遣返方面的差距。该方法揭示了每个需求的原因和广泛影响，以及它们之间的相互作用。参与者提出了包括组织和教育/临床解决方案在内的解决方案。
本研究在复杂的跨专业、跨医院环境中捕获了需求，可以针对这些需求实施有针对性的干预措施，以改善社区医院的患者预后。此外，本研究提供了在这种环境中进行需求评估的初步框架和严格方法。
