Division of General Pediatrics, Department of Pediatrics, Children's Hospital of Philadelphia, USA; The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, USA.
Care Network, Children's Hospital of Philadelphia, USA.
J Pediatr Nurs. 2022 Jul-Aug;65:22-28. doi: 10.1016/j.pedn.2022.03.013. Epub 2022 Apr 7.
Pediatric primary care redesign includes changes to clinical teams and clinical workflows. This study described the perspectives of pediatric clinicians on their experience with redesign.
This qualitative study explored clinician perspectives on a newborn care redesign pilot at a pediatric primary care site. Newborn Hallway (NBH), implemented in 2019, clustered morning newborn visits with a single physician, increased RN staffing, and provided newborn-specific training for RNs. NBH also revised visit documentation templates to promote communication between RNs and physicians and shared completion of history taking and education. We conducted semi-structured qualitative interviews with clinicians. The interview guide was developed using the Consolidated Framework for Implementation Research. Interviews were recorded and transcribed, and coded using an integrated approach.
We interviewed 17 staff (8 physicians, 8 RNs, 1 nurse practitioner) from 3/2020 to 1/2021. Clinicians reported that NBH implementation was facilitated by widespread agreement on baseline challenges to newborn care, and interest in optimizing roles for RNs. Clinicians believed NBH facilitated teamwork, which mitigated unpredictability in newborn needs and arrival times, and improved staff satisfaction. Perceived barriers to NBH included staffing constraints and ambivalence about whether sharing tasks with RNs would negatively influence patient relationships and continuity.
Pediatric primary care redesign focused on sharing tasks between RNs and physicians can promote teamwork and address unpredictability in clinical settings.
Resolving questions about how redesign influences patient continuity and trust, and clarifying optimal staffing may help facilitate adoption of clinical team and workflow innovations.
儿科初级保健的重新设计包括对临床团队和临床工作流程的改变。本研究描述了儿科临床医生对重新设计体验的看法。
本定性研究探讨了临床医生对儿科初级保健点新生儿护理重新设计试点的看法。新生儿走廊（NBH）于 2019 年实施，将早上的新生儿就诊与一名医生集中在一起，增加了注册护士的人员配备，并为注册护士提供了新生儿特定的培训。NBH 还修改了就诊记录模板，以促进注册护士和医生之间的沟通，并共同完成病史采集和教育。我们对临床医生进行了半结构化定性访谈。访谈指南是使用实施研究综合框架制定的。访谈进行了录音和转录，并采用综合方法进行编码。
我们在 2020 年 3 月至 2021 年 1 月期间对 17 名工作人员（8 名医生、8 名注册护士、1 名护士从业者）进行了采访。临床医生报告说，NBH 的实施得到了广泛的认同，即对新生儿护理的基线挑战达成共识，以及对优化注册护士角色的兴趣。临床医生认为 NBH 促进了团队合作，缓解了新生儿需求和到达时间的不可预测性，并提高了员工满意度。NBH 被认为存在障碍，包括人员配备限制，以及对与注册护士分担任务是否会对患者关系和连续性产生负面影响持矛盾态度。
儿科初级保健的重新设计侧重于注册护士和医生之间的任务共享，可以促进团队合作，并解决临床环境中的不可预测性。
解决重新设计如何影响患者连续性和信任的问题，并明确最佳人员配备，可能有助于促进临床团队和工作流程创新的采用。
