Gawronski Orsola, Parshuram Christopher, Cecchetti Corrado, Tiozzo Emanuela, Ciofi Degli Atti Marta Luisa, Dall'Oglio Immacolata, Scarselletta Gianna, Offidani Caterina, Raponi Massimiliano, Latour Jos M
Continuing Education and Nursing Research Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
BMJ Paediatr Open. 2018 May 24;2(1):e000241. doi: 10.1136/bmjpo-2017-000241. eCollection 2018.
System-level interventions including rapid response teams and paediatric early warning scores have been designed to support escalation of care and prevent severe adverse events in hospital wards. Barriers and facilitators to escalation of care have been rarely explored in paediatric settings.
This study explores the experiences of parents and healthcare professionals of in-hospital paediatric clinical deterioration events to identify factors associated with escalation of care.
Across 2 hospital sites, 6 focus groups with 32 participants were conducted with parents (n=9) and healthcare professionals (n=23) who had cared for or witnessed a clinical deterioration event of a child. Transcripts of audio recording were analysed for emergent themes using a constant comparative approach.
Four themes and 19 subthemes were identified: (1) impact of staff competencies and skills, including personal judgement of clinical efficacy (self-efficacy), differences in staff training and their impact on perceived nursing credibility; (2) impact of relationships in care focusing on communication and teamwork; (3) processes identifying and responding to clinical deterioration, such as patient assessment practices, tools to support the identification of patients at risk and the role of the rapid response team; and (4) influences of organisational factors on escalation of care, such as staffing, patient pathways and continuity of care.
Findings emphasise the considerable influence of social processes such as teamwork, communication, models of staff organisation and staff education. Further studies are needed to better understand how modification of these factors can be used to improve patient safety.
包括快速反应小组和儿科早期预警评分在内的系统层面干预措施旨在支持医院病房护理级别提升并预防严重不良事件。在儿科环境中，护理级别提升的障碍和促进因素很少被探讨。
本研究探讨家长和医护人员对儿科住院临床病情恶化事件的经历，以确定与护理级别提升相关的因素。
在2个医院地点，对9名家长和23名医护人员进行了6个焦点小组访谈，这些家长和医护人员曾照顾或目睹过儿童临床病情恶化事件。使用持续比较法对录音文本进行分析，以找出新出现的主题。
确定了4个主题和19个子主题：（1）工作人员能力和技能的影响，包括对临床疗效的个人判断（自我效能）、工作人员培训差异及其对护理可信度的影响；（2）护理中关系的影响，重点是沟通和团队合作；（3）识别和应对临床病情恶化的过程，如患者评估实践、支持识别高危患者的工具以及快速反应小组的作用；（4）组织因素对护理级别提升的影响，如人员配备、患者就医流程和护理连续性。
研究结果强调了团队合作、沟通、人员组织模式和人员教育等社会过程的重大影响。需要进一步研究以更好地理解如何通过改变这些因素来提高患者安全。
