在发热儿童管理中应用即时检测的作用：英格兰基于医院的医生和护士的定性研究。
Role of point-of-care tests in the management of febrile children: a qualitative study of hospital-based doctors and nurses in England.
机构信息
Clinical Research Department, Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, London, UK.
Patient Safety Translational Research Centre, Institute of Global Health Innovation, Department of Surgery & Cancer, Imperial College, London, UK.
出版信息
BMJ Open. 2021 May 10;11(5):e044510. doi: 10.1136/bmjopen-2020-044510.
OBJECTIVES
The use of rapid point-of-care tests (POCTs) has been advocated for improving patient management and outcomes and for optimising antibiotic prescribing. However, few studies have explored healthcare workers' views about their use in febrile children. The aim of this study was to explore the perceptions of hospital-based doctors and nurses regarding the use of POCTs in England.
STUDY DESIGN
Qualitative in-depth interviews with purposively selected hospital doctors and nurses. Data were analysed thematically.
SETTING
Two university teaching hospitals in London and Newcastle.
PARTICIPANTS
24 participants (paediatricians, emergency department doctors, trainee paediatricians and nurses).
RESULTS
There were diverse views about the use of POCTs in febrile children. The reported advantages included their ease of use and the rapid availability of results. They were seen to contribute to faster clinical decision-making; the targeting of antibiotic use; improvements in patient care, flow and monitoring; cohorting (ie, the physical clustering of hospitalised patients with the same infection to limit spread) and enhancing communication with parents. These advantages were less evident when the turnaround for results of laboratory tests was 1-2 hours. Factors such as clinical experience and specialty, as well as the availability of guidelines recommending POCT use, were also perceived as influential. However, in addition to their perceived inaccuracy, participants were concerned about POCTs not resolving diagnostic uncertainty or altering clinical management, leading to a commonly expressed preference for relying on clinical skills rather than test results solely.
CONCLUSION
In this study conducted at two university teaching hospitals in England, participants expressed mixed opinions about the utility of current POCTs in the management of febrile children. Understanding the current clinical decision-making process and the specific needs and preferences of clinicians in different settings will be critical in ensuring the optimal design and deployment of current and future tests.
目的
快速床边检测（POCT）的应用被提倡用于改善患者管理和结局，并优化抗生素的使用。然而，很少有研究探讨医护人员对其在发热儿童中的使用的看法。本研究旨在探讨英格兰医院医生和护士对 POCT 使用的看法。
研究设计
对医院医生和护士进行有针对性的深入访谈。对数据进行主题分析。
地点
伦敦和纽卡斯尔的两所大学教学医院。
参与者
24 名参与者（儿科医生、急诊医生、儿科实习医生和护士）。
结果
对于 POCT 在发热儿童中的使用存在不同的看法。报告的优点包括其易于使用和快速获得结果。它们被认为有助于更快的临床决策、抗生素的靶向使用、改善患者护理、流程和监测、群体（即，将患有相同感染的住院患者物理上分组以限制传播）以及加强与家长的沟通。当实验室检测结果的周转时间为 1-2 小时时，这些优势就不太明显了。临床经验和专业知识等因素，以及推荐使用 POCT 的指南的可用性，也被认为是有影响的。然而，除了他们认为的不准确性之外，参与者还担心 POCT 不能解决诊断不确定性或改变临床管理，导致普遍表达了更倾向于依赖临床技能而不是仅依赖测试结果的偏好。
结论
在这项在英格兰两所大学教学医院进行的研究中，参与者对当前 POCT 在发热儿童管理中的实用性表达了混合的看法。了解当前的临床决策过程以及不同环境中临床医生的具体需求和偏好，对于确保当前和未来测试的最佳设计和部署至关重要。
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