Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK
Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, Tyne and Wear, UK.
BMJ Open. 2019 Dec 11;9(12):e032925. doi: 10.1136/bmjopen-2019-032925.
Around one in five emergency hospital admissions are affected by acute kidney injury (AKI). To address poor quality of care in relation to AKI, electronic alerts (e-alerts) are mandated across primary and secondary care in England and Wales. Evidence of the benefit of AKI e-alerts remains conflicting, with at least some uncertainty explained by poor or unclear implementation. The objective of this study was to identify factors relating to implementation, using Normalisation Process Theory (NPT), which promote or inhibit use of AKI e-alerts in secondary care.
Mixed methods combining qualitative (observations, semi-structured interviews) and quantitative (survey) methods.
Three secondary care hospitals in North East England, representing two distinct AKI e-alerting systems. Observations (>44 hours) were conducted in Emergency Assessment Units (EAUs). Semi-structured interviews were conducted with clinicians (n=29) from EAUs, vascular or general surgery or care of the elderly. Qualitative data were supplemented by Normalization MeAsure Development (NoMAD) surveys (n=101).
Qualitative data were analysed using the NPT framework, with quantitative data analysed descriptively and using χ and Wilcoxon signed-rank test for differences in current and future normalisation.
Participants reported familiarity with the AKI e-alerts but that the e-alerts would become more normalised in the future (p<0.001). No single NPT mechanism led to current (un)successful implementation of the e-alerts, but analysis of the underlying subconstructs identified several mechanisms indicative of successful normalisation (internalisation, ) or unsuccessful normalisation (, , , systematisation).
Clinicians recognised the value and importance of AKI e-alerts in their practice, although this was not sufficient for the e-alerts to be routinely engaged with by clinicians. To further normalise the use of AKI e-alerts, there is a need for tailored training on use of the e-alerts and routine feedback to clinicians on the impact that e-alerts have on patient outcomes.
约五分之一的急诊住院患者受到急性肾损伤（AKI）的影响。为了解决 AKI 护理质量差的问题，英国和威尔士的初级和二级保健机构都强制使用电子警报（e-alerts）。AKI e-alerts 的益处的证据仍然存在冲突，至少有一些不确定性可以通过实施情况差或不明确来解释。本研究的目的是使用规范化进程理论（NPT）确定与实施相关的因素，这些因素促进或抑制二级保健中 AKI e-alerts 的使用。
结合定性（观察、半结构化访谈）和定量（调查）方法的混合方法。
英格兰东北部的三家二级保健医院，代表两种不同的 AKI 警报系统。在急症评估单位（EAUs）进行了超过 44 小时的观察。对来自急症评估单位、血管或普外科或老年护理科的临床医生（n=29）进行了半结构化访谈。定性数据由规范化测量开发（NoMAD）调查（n=101）补充。
使用 NPT 框架分析定性数据，使用描述性方法和 χ 和 Wilcoxon 符号秩检验分析当前和未来规范化的差异。
参与者报告熟悉 AKI e-alerts，但 e-alerts 在未来会更加规范化（p<0.001）。没有单一的 NPT 机制导致当前（未）成功实施 e-alerts，但对潜在子结构的分析确定了几个表明成功规范化（内化）或不成功规范化（、、、系统化）的机制。
临床医生认识到 AKI e-alerts 在实践中的价值和重要性，尽管这还不足以使临床医生常规使用 e-alerts。为了进一步规范 AKI e-alerts 的使用，需要针对 e-alerts 的使用进行有针对性的培训，并定期向临床医生反馈 e-alerts 对患者结果的影响。
