Grande-Ratti Maria Florencia, Perez-Manelli Romina Yasmin, Herrera Ana Gabriela, Pedretti Ana Soledad, Aliperti Valeria, Martinez Bernardo, Dawidowski Adriana Ruth
Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Área de Investigación en Medicina Interna, Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
Arch Prev Riesgos Labor. 2022 Jul 15;25(3):242-258. doi: 10.12961/aprl.2022.25.03.02.
To explore perceptions, concerns and needs of healthcare professionals in an emergency department (ED) from Argentina.
Participatory action research, coordinated and carried out by ED healthcare professionals, which included physicians, nurses and administrative staff who actively engaged in both data collection and analysis. Mixed methodologies were used: documentary analysis of complaints and written claims by patients, 10 individual interviews, and two reflective focus groups of 10 healthcare professionals (who differed in occupation, seniority and experience, including residents in training).
The topics that emerged were work factors that lead to errors and threaten patient-centered clinical encounters: work overload and lack of time, the overuse of resources for defensive medicine purposes and technology that replaces physical contact. Healthcare professionals reported episodes of aggression by patients or their families, when long waits and structural insufficiencies (such as lack of beds, saturation of the waiting room, discomfort) threaten patience and tolerance. From these insights, improvements were generated in various areas of the ED.
The identification of problems by the ED stakeholders l was a relevant approach that led to a process of collective management change, promoted reflection and raised awareness, allowing the identification of areas for improvement, design strategies and concrete feasible proposals.
探讨阿根廷急诊科医护人员的看法、关切和需求。
参与式行动研究,由急诊科医护人员协调并开展,参与人员包括积极参与数据收集和分析的医生、护士及行政人员。采用了混合方法:对患者投诉和书面索赔进行文献分析、10次个人访谈以及两个由10名医护人员组成的反思焦点小组(他们在职业、资历和经验方面存在差异,包括实习住院医师)。
出现的主题包括导致错误并威胁以患者为中心的临床诊疗过程的工作因素:工作负担过重和时间不足、为防御性医疗目的过度使用资源以及取代身体接触的技术。医护人员报告称,当长时间等待和结构缺陷(如床位不足、候诊室饱和、环境不适)威胁到患者及其家属的耐心和忍耐力时,会发生患者或其家属的攻击事件。基于这些见解,急诊科的各个领域都有了改进。
急诊科利益相关者对问题的识别是一种相关方法,它导致了集体管理变革的过程,促进了反思并提高了认识,从而能够识别改进领域、设计策略和具体可行的建议。