改善危重症患者院内转运期间的质量和安全：一项关键事件研究。
Improving quality and safety during intrahospital transport of critically ill patients: A critical incident study.
机构信息
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden.
Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, PO Box 457, SE-405 30, Gothenburg, Sweden; Vascular Department, Sahlgrenska University Hospital, SE-413 45, Gothenburg, Sweden.
出版信息
Aust Crit Care. 2020 Jan;33(1):12-19. doi: 10.1016/j.aucc.2018.12.003. Epub 2019 Jan 21.
BACKGROUND
Intrahospital transport is a high-risk procedure for critically ill patients, yet there is little known about how the transport team manages critical incidents that occur.
OBJECTIVES
The aim of this study was to explore critical care nurses' and physicians' experiences and practices associated with critical incidents during the transfer process in critically ill patients.
METHODS
As a part of an ethnographic study, semistructured interviews were performed using the critical incident technique. Data were collected in two intensive care units at one university hospital in a Swedish metropolitan city. Critical care nurses (n = 15) and physicians (n = 5) were interviewed, together describing a total of 46 critical incidents. Data were analysed using qualitative content and thematic analysis approaches.
RESULTS
Content analysis of nurses' and physicians' practices resulted in a description of requirements for safe transports, including organisational prerequisites, professional skills and attributes, as well as actions and behaviours of safely performing transfers. Exploring the experiences of nurses and physicians in transporting critically ill patients yielded three main themes. The first theme, a hazardous process, revealed how caring for critically ill patients during intrahospital transfers was perceived as an unsafe, demanding task that presents several threats to the patient's safety. However, despite worries and concerns, participants trusted their own abilities to handle unexpected events, resulting in the second theme, performing when it matters. The third theme, towards safe practice, captured suggestions for improvement and attitudes towards existing safety hazards.
CONCLUSIONS
To prevent and manage critical incidents during intrahospital transport, findings of this study suggest that nontechnical skills such as situational awareness and teamwork are essential. In addition, the team must possess the requisite technical skills and knowledge to undertake transports. Finally, organisations are required to provide a supportive and sustainable transport environment that includes fewer transport-related hazards.
背景
院内转运对危重症患者来说是一项高风险的操作，但对于转运团队如何应对转运过程中发生的危急事件，我们知之甚少。
目的
本研究旨在探讨危重症护理人员和医师在转运危重症患者过程中处理危急事件的经验和做法。
方法
作为一项人种学研究的一部分，我们使用关键事件技术进行了半结构化访谈。数据收集于瑞典大都市区一所大学医院的两个重症监护病房。共对 15 名重症监护护士和 5 名医师进行了访谈，他们总共描述了 46 起危急事件。使用定性内容分析和主题分析方法对数据进行分析。
结果
对护士和医师实践的内容分析得出了安全转运的要求描述，包括组织前提条件、专业技能和属性，以及安全转运的行动和行为。对护士和医师转运危重症患者的经验进行探讨得出了三个主要主题。第一个主题，一个危险的过程，揭示了在院内转运期间照顾危重症患者被认为是一项不安全且要求苛刻的任务，对患者的安全存在诸多威胁。然而，尽管存在担忧和顾虑，参与者还是相信自己有能力处理意外事件，从而产生了第二个主题，在关键时刻执行。第三个主题，走向安全实践，捕捉到了改进建议和对现有安全隐患的态度。
结论
为了预防和管理院内转运过程中的危急事件，本研究的结果表明，非技术技能，如情境意识和团队合作，至关重要。此外，团队必须具备进行转运所需的必要技术技能和知识。最后，组织需要提供一个支持性和可持续的转运环境，减少与转运相关的危害。
Zotero 插件