Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
Pediatr Crit Care Med. 2021 Feb 1;22(2):172-180. doi: 10.1097/PCC.0000000000002595.
To explore interrupters' and interruptees' experiences of interruptions occurring during morning rounds in a PICU in an attempt to understand better how to limit interruptions that threaten patient safety.
Qualitative ethnographic study including observations, field interviews, and in-depth interviews.
A 55-bed PICU in a free-standing, quaternary-care children's hospital.
Attending physicians, fellow physicians, frontline clinicians (resident physicians and nurse practitioners), and nurses working in the PICU.
Data collection occurred in two parts: 1) field observations during morning rounds with brief field interviews conducted with participants involved in an observed interruption and 2) in-depth interviews conducted with selected participants from prior field observations.
Data were coded using a constant comparative method with thematic analysis, clustering codes into groups, and subsequently into themes. We observed 11 rounding encounters (17 hr of observation and 48 patient encounters), conducting 25 field interviews and eight in-depth interviews. Themes included culture of interruption triage, interruption triage criteria, and barriers to interruption triage. Interruptees desired forming a culture of triage, whereby less-urgent interruptions were deferred until later or addressed through an asynchronous method; this desire was misaligned with interrupters who described ongoing interruption triage based on clinical changes, time-sensitivity, and interrupter comfort, despite not having a formal triage algorithm. Barriers to interruption triage included a lack of situational awareness and experience among interrupters and interruptees.
Interrupters and interruptees did not have a shared understanding of the culture of triage within the PICU. Although interrupters attempted to triage interruptions, no formal triage algorithm existed and interruptees did not perceive a triaging culture. Using data from this study, we created a triage algorithm that could inform future studies, potentially decrease unnecessary interruptions, and optimize information sharing for essential interruptions.
探索在儿科重症监护病房（PICU）晨间查房期间发生的中断事件中，中断者和被中断者的体验，试图更好地理解如何限制威胁患者安全的中断。
包括观察、现场访谈和深入访谈的定性民族志研究。
一家独立的四级儿童医院的 55 张床位的 PICU。
主治医生、住院医生、一线临床医生（住院医生和护士从业者）和在 PICU 工作的护士。
数据收集分为两部分进行：1）在晨间查房期间进行实地观察，并对参与观察中断事件的参与者进行简短的现场访谈；2）对之前实地观察中选择的参与者进行深入访谈。
使用恒定比较法进行数据编码，采用主题分析方法，将代码聚类为组，然后聚类为主题。我们观察了 11 次查房（17 小时的观察和 48 次患者查房），进行了 25 次现场访谈和 8 次深入访谈。主题包括中断分诊文化、中断分诊标准和中断分诊障碍。被中断者希望形成分诊文化，将不那么紧急的中断推迟到以后处理，或者通过异步方法处理；这种愿望与中断者不一致，中断者描述了根据临床变化、时间敏感性和中断者的舒适度进行持续的中断分诊，尽管他们没有正式的分诊算法。中断分诊的障碍包括中断者和被中断者缺乏情境意识和经验。
中断者和被中断者对 PICU 中断分诊文化没有共同的理解。尽管中断者试图对中断进行分诊，但没有正式的分诊算法，被中断者也没有察觉到分诊文化。利用本研究的数据，我们创建了一个分诊算法，可以为未来的研究提供信息，有可能减少不必要的中断，并优化重要中断的信息共享。
