Department of Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.
Department of Pediatrics, Hasbro Children's Hospital, Providence, Rhode Island, USA.
BMJ Qual Saf. 2019 Mar;28(3):215-222. doi: 10.1136/bmjqs-2018-008065. Epub 2018 Aug 12.
Emergency medicine and paediatric hospital medicine physicians each provide a portion of the initial clinical care for the majority of hospitalised children in the USA. While these disciplines share goals to increase quality of care, there are scant data describing their collaboration. Our national, multihospital learning collaborative, which aimed to increase narrow-spectrum antibiotic prescribing for paediatric community-acquired pneumonia, provided an opportunity to examine factors influencing the success of quality improvement efforts across these two clinical departments.
To identify barriers to and facilitators of interdepartmental quality improvement implementation, with a particular focus on increasing narrow-spectrum antibiotic use in the emergency department and inpatient settings for children hospitalised with pneumonia.
We used a mixed-methods design, analysing interviews, written reports and quality measures. To describe hospital characteristics and quality measures, we calculated medians/IQRs for continuous variables, frequencies for categorical variables and Pearson correlation coefficients. We conducted in-depth, semistructured interviews by phone with collaborative site leaders; interviews were transcribed verbatim and, with progress reports, analysed using a general inductive approach.
47 US-based hospitals were included in this analysis. Qualitative analysis of 35 interview transcripts and 142 written reports yielded eight inter-related domains that facilitated successful interdepartmental quality improvement: (1) hospital leadership and support, (2) quality improvement champions, (3) evidence supporting the intervention, (4) national health system influences, (5) collaborative culture, (6) departments' structure and resources, (7) quality improvement implementation strategies and (8) interdepartmental relationships.
The conceptual framework presented here may be used to identify hospitals' strengths and potential barriers to successful implementation of quality improvement efforts across clinical departments.
在美国，急诊医学和儿科医院医学医师都为大多数住院儿童提供初始临床护理的一部分。尽管这些学科的目标是提高护理质量，但很少有数据描述它们的合作。我们的全国性多医院学习合作组织旨在增加窄谱抗生素治疗小儿社区获得性肺炎的处方，为研究影响这两个临床科室质量改进工作成功的因素提供了机会。
确定跨部门质量改进实施的障碍和促进因素，特别关注增加急诊科和住院病房窄谱抗生素的使用，用于患有肺炎住院的儿童。
我们使用混合方法设计，分析访谈、书面报告和质量措施。为了描述医院特征和质量措施，我们计算了连续变量的中位数/IQR、分类变量的频率和 Pearson 相关系数。我们通过电话对合作地点的领导进行了深入的半结构化访谈；访谈逐字记录，并与进展报告一起使用一般归纳方法进行分析。
本分析包括 47 家美国医院。对 35 份访谈记录和 142 份书面报告的定性分析产生了八个相互关联的领域，这些领域促进了跨部门质量改进的成功：（1）医院领导和支持，（2）质量改进冠军，（3）支持干预的证据，（4）国家卫生系统的影响，（5）合作文化，（6）部门的结构和资源，（7）质量改进实施策略，（8）部门间关系。
这里提出的概念框架可用于确定医院在跨临床科室实施质量改进工作的优势和潜在障碍。
