临床医生对学术医疗中心中快速反应系统有效实施的障碍的看法：一项焦点小组研究。
Clinician Perspectives of Barriers to Effective Implementation of a Rapid Response System in an Academic Health Centre: A Focus Group Study.
机构信息
Faculty of Health, University of Technology Sydney, Ultimo, Australia.
School of Nursing, Johns Hopkins University, Baltimore, MD, USA.
出版信息
Int J Health Policy Manag. 2017 Aug 1;6(8):447-456. doi: 10.15171/ijhpm.2016.156.
BACKGROUND
Systemic and structural issues of rapid response system (RRS) models can hinder implementation. This study sought to understand the ways in which acute care clinicians (physicians and nurses) experience and negotiate care for deteriorating patients within the RRS.
METHODS
Physicians and nurses working within an Australian academic health centre within a jurisdictional-based model of clinical governance participated in focus group interviews. Verbatim transcripts were analysed using thematic content analysis.
RESULTS
Thirty-four participants (21 physicians and 13 registered nurses [RNs]) participated in six focus groups over five weeks in 2014. Implementing the RRS in daily practice was a process of informal communication and negotiation in spite of standardised protocols. Themes highlighted several systems or organisational-level barriers to an effective RRS, including (1) responsibility is inversely proportional to clinical experience; (2) actions around system flexibility contribute to deviation from protocol; (3) misdistribution of resources leads to perceptions of inadequate staffing levels inhibiting full optimisation of the RRS; and (4) poor communication and documentation of RRS increases clinician workloads.
CONCLUSION
Implementing a RRS is complex and multifactorial, influenced by various inter- and intra-professional factors, staffing models and organisational culture. The RRS is not a static model; it is both reflexive and iterative, perpetually transforming to meet healthcare consumer and provider demands and local unit contexts and needs. Requiring more than just a strong initial implementation phase, new models of care such as a RRS demand good governance processes, ongoing support and regular evaluation and refinement. Cultural, organizational and professional factors, as well as systems-based processes, require consideration if RRSs are to achieve their intended outcomes in dynamic healthcare settings.
背景
快速反应系统（RRS）模型的系统和结构问题可能会阻碍其实施。本研究旨在了解急性护理临床医生（医生和护士）在 RRS 内体验和协商对病情恶化患者的护理的方式。
方法
在以临床治理为基础的司法模式下，在澳大利亚学术医疗中心工作的医生和护士参加了焦点小组访谈。使用主题内容分析对逐字记录进行了分析。
结果
2014 年的五周内，34 名参与者（21 名医生和 13 名注册护士[RNs]）参加了六个焦点小组。尽管有标准化协议，但在日常实践中实施 RRS 是一个非正式沟通和协商的过程。主题突出了几个系统或组织层面的障碍，包括（1）责任与临床经验成反比；（2）围绕系统灵活性的行动导致偏离协议；（3）资源分配不当导致人员配备不足的看法，这抑制了 RRS 的充分优化；（4）RRS 的沟通和文档记录不佳增加了临床医生的工作量。
结论
实施 RRS 是复杂的、多因素的，受到各种专业内部和专业之间的因素、人员配备模式和组织文化的影响。RRS 不是一个静态的模型；它既是反思性的，也是迭代性的，不断转变以满足医疗保健消费者和提供者的需求以及当地单位的情况和需求。新的护理模式（如 RRS）不仅需要一个强大的初始实施阶段，还需要良好的治理过程、持续的支持以及定期的评估和改进。如果 RRS 要在动态医疗环境中实现其预期结果，就需要考虑文化、组织和专业因素以及基于系统的流程。
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