Ratnapalan Savithiri, Bennett Chris, Dopson Sue, Darwent Melanie
Author Affiliations: Department of Paediatrics and Dalla Lana School of Public Health, University of Toronto; and Divisions of Emergency Medicine, Clinical Pharmacology & Toxicology, Hospital for Sick Children (Dr Ratnapalan), Toronto, Ontario, Canada; Kings College London (Mrs Bennett); and Saïd Business School, University of Oxford (Dr Dopson); and Oxford University Hospitals (Dr Darwent), Oxford, United Kingdom.
Health Care Manag (Frederick). 2019 Jan/Mar;38(1):29-36. doi: 10.1097/HCM.0000000000000251.
The objective of this study was to identify staff perceptions of a service improvement for pediatric emergency care at a university teaching hospital. Semistructured qualitative interviews of stakeholders were conducted, and grounded theory approach was used for analysis. Forty-one interviews were conducted with physicians, nurses, managers, and health care workers. Major themes emerging from the analysis included the physical space of and flow within the pediatric emergency department (ED), impact of technology, staffing in the ED, the effects of frontline pediatricians and emergency physicians managing children in the ED, and the need for and expectations of a pediatric emergency medicine (PEM) consultant. Human interactions among health care providers, leadership, and teaching are considered as equally important as providing the appropriate environment and qualified professionals for improving care for children in the ED. Appointment of a PEM consultant was suggested to provide leadership and education to manage relationships and implement changes. Subsequent to the study, the model of care for PEM was changed, the pediatric care delivery became more integrated with the main ED, and two PEM consultants were appointed to the institution.
本研究的目的是确定大学教学医院工作人员对改善儿科急诊护理服务的看法。对利益相关者进行了半结构化定性访谈，并采用扎根理论方法进行分析。对医生、护士、管理人员和医护人员进行了41次访谈。分析得出的主要主题包括儿科急诊科（ED）的物理空间和内部流程、技术的影响、急诊科的人员配备、一线儿科医生和急诊医生在急诊科管理儿童的效果，以及对儿科急诊医学（PEM）顾问的需求和期望。医疗服务提供者、领导层和教学之间的人际互动被认为与为改善急诊科儿童护理提供适当环境和合格专业人员同样重要。建议任命一名PEM顾问来提供领导和教育，以管理关系并实施变革。研究之后，PEM的护理模式发生了变化，儿科护理服务与主要急诊科的整合度更高，并且该机构任命了两名PEM顾问。
