Davis Katherine Finn, Rosenblatt Samuel, Buffman Hayley, Polikoff Lee, Napolitano Natalie, Giuliano John S, Sanders Ronald C, Edwards Lauren R, Krishna Ashwin S, Parsons Simon J, Al-Subu Awni, Krawiec Conrad, Harwayne-Gidansky Ilana, Vanderford Paula, Salfity Nina, Lane-Fall Meghan, Nadkarni Vinay, Nishisaki Akira
School of Nursing and Dental Hygiene, University of Hawai'i at Mānoa, Honolulu, HI.
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA.
Am J Med Qual. 2022;37(3):255-265. doi: 10.1097/JMQ.0000000000000032. Epub 2021 Dec 21.
To better understand facilitators and barriers to implementation of quality improvement (QI) efforts, this study examined 2 evidence-based interventions, video laryngoscopy (VL)-assisted coaching, and apneic oxygenation (AO). One focus group with frontline clinicians was held at each of the 10 participating pediatric intensive care units. Qualitative analysis identified common and unique themes. Intervention fidelity was monitored with a priori defined success as >50% VL-assisted coaching or >80% AO use for 3 consecutive months. Eighty percent of intensive care units with VL-assisted coaching and 20% with AO met this criteria during the study period. Common facilitator themes were adequate device accessibility, having a QI culture, and strong leadership. Common barrier themes included poor device accessibility and perception of delay in care. A consistently identified theme in the successful sites was strong QI leadership, while unsuccessful sites consistently identified insufficient education. These facilitators and barriers should be proactively addressed during dissemination of these interventions.
为了更好地理解实施质量改进（QI）工作的促进因素和障碍，本研究考察了两种循证干预措施，即视频喉镜（VL）辅助培训和无呼吸给氧（AO）。在10个参与研究的儿科重症监护病房分别与一线临床医生进行了一次焦点小组讨论。定性分析确定了共同主题和独特主题。通过预先定义连续3个月VL辅助培训成功率>50%或AO使用率>80%来监测干预保真度。在研究期间，80%采用VL辅助培训的重症监护病房和20%采用AO的重症监护病房达到了这一标准。常见的促进因素主题包括设备可及性良好、拥有质量改进文化以及强有力的领导。常见的障碍主题包括设备可及性差和认为护理延迟。在成功的场所中始终确定的一个主题是强有力的质量改进领导，而不成功的场所则始终认为教育不足。在推广这些干预措施时，应积极应对这些促进因素和障碍。
