Lombardo Chiara, Santos Mónica, Van Bortel Tine, Croos Robert, Arensman Ella, Kar Ray Manaan
Institute for Health and Human Development, University of East London,UK.
Adult Mental Health Services,Cambridgeshire and Peterborough NHS Foundation Trust,UK.
BJPsych Bull. 2019 Apr;43(2):61-66. doi: 10.1192/bjb.2018.94. Epub 2018 Nov 19.
Aims and methodThe aim of the study is to improve patient safety by identifying factors influencing gatekeeping decisions by crisis resolution and home treatment teams. A theoretical sampling method was used to recruit clinicians. Semi-structured interviews to elicit various aspects of clinical decision-making were carried out. The transcripts were thematically analysed using a grounded theory approach. RESULTS: Patient needs (safety and treatment) was the primary driver behind decisions. The research also revealed that information gathered was processed using heuristics. We identified five key themes (anxiety, weighting, agenda, resource and experience), which were constructed into an acronym 'AWARE'.Clinical implicationsAWARE provides a framework to make explicit drivers for decision-making that are often implicit. Incorporating these drivers into reflective practice will help staff be more mindful of undue influences and result in improved clinical decisions.Declaration of interestNone.
目的与方法
本研究的目的是通过识别影响危机解决和家庭治疗团队守门决策的因素来提高患者安全。采用理论抽样方法招募临床医生。进行了半结构化访谈以引出临床决策的各个方面。使用扎根理论方法对访谈记录进行了主题分析。
患者需求(安全与治疗)是决策背后的主要驱动因素。研究还表明,收集到的信息是通过启发式方法处理的。我们确定了五个关键主题(焦虑、权重、议程、资源和经验),将其构建成首字母缩写词“AWARE”。
临床意义
AWARE提供了一个框架,用于明确那些通常是隐性的决策驱动因素。将这些驱动因素纳入反思性实践将有助于工作人员更加留意不当影响,并改善临床决策。
利益声明
无。