McCarty Emily J, Nagarajan Meera K, Halloran Sean R, Brady Robert E, House Samantha A, Leyenaar JoAnna K
Department of Pediatrics, Children's Hospital at Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Department of Pediatrics, Kootenai Health, Coeur d'Alene, Idaho, USA.
J Hosp Med. 2022 Oct;17(10):783-792. doi: 10.1002/jhm.12906. Epub 2022 Jul 7.
Following initial evaluation and management, youth requiring inpatient psychiatric care often experience boarding, defined as being held in the emergency department or another location while awaiting inpatient care. Although mental health boarding is common, little research has examined the quality of healthcare delivery during the boarding period.
This study aimed to explore the perspectives and experiences of multidisciplinary clinicians and parents regarding mental health boarding and to develop a conceptual model to inform quality improvement efforts.
DESIGN, SETTING, & PARTICIPANTS: We conducted semistructured interviews with clinicians and parents of youth experiencing boarding. Interviews focused on experiences of care and perceived opportunities for improvement were continued until thematic saturation was reached. Interviews were recorded, transcribed, and analyzed to identify emergent themes using a general inductive approach. Axial coding was used to inform conceptual framework development.
Interviews were conducted with 19 clinicians and 11 parents. Building on the Donabedian structure-process-outcome model of quality evaluation, emergent domains, and associated themes included: (1) infrastructure for healthcare delivery, including clinician training, healthcare team composition, and the physical environment; (2) processes of healthcare delivery, including clinician roles and responsibilities, goals of care, communication with families, policies/procedures, and logistics of inter-facility transfer; and (3) measurable outcomes, including patient safety, family experience, mental health status, timeliness of care, and clinician moral distress.
This qualitative study summarizes clinician and family perspectives about care for youth experiencing boarding. The conceptual model resulting from this analysis can be applied to implement and evaluate quality improvement endeavors to support this vulnerable population.
在初步评估和管理之后，需要住院精神科护理的青少年常常经历“滞留”，即被安置在急诊科或其他场所等待住院护理。尽管精神科滞留现象很常见，但很少有研究探讨滞留期间的医疗服务质量。
本研究旨在探究多学科临床医生和家长对精神科滞留的看法和经历，并构建一个概念模型，为质量改进工作提供参考。
设计、背景与参与者：我们对经历滞留的青少年的临床医生和家长进行了半结构式访谈。访谈聚焦于护理经历和感知到的改进机会，持续进行直至达到主题饱和。访谈进行录音、转录，并采用一般归纳法进行分析以识别新出现的主题。运用轴心编码为概念框架的构建提供信息。
对19名临床医生和11名家长进行了访谈。基于多纳贝迪安质量评估的结构-过程-结果模型，新出现的领域及相关主题包括：（1）医疗服务提供的基础设施，包括临床医生培训、医疗团队组成和物理环境；（2）医疗服务提供的过程，包括临床医生的角色和职责、护理目标、与家庭的沟通、政策/程序以及机构间转运的后勤工作；（3）可衡量的结果，包括患者安全、家庭体验、心理健康状况、护理及时性以及临床医生的道德困扰。
这项定性研究总结了临床医生和家庭对经历滞留的青少年护理的看法。该分析得出的概念模型可应用于实施和评估质量改进工作，以支持这一弱势群体。
