Garcia Marcos Vinicius Fernandes, Rikabi Sarah, Krishtopaytis Eduard, Henderson Katrina M, Al-Jaghbeer Mohammed J, Fadell Francois
Cleveland Clinic Foundation, Fairview Hospital, Cleveland, Ohio; and.
Respiratory Institute, Cleveland Clinic Foundation, Cleveland, Ohio.
ATS Sch. 2024 Feb 12;5(2):311-321. doi: 10.34197/ats-scholar.2023-0111IN. eCollection 2024 Jun 1.
Hospitals are required to have rapid response (RR) systems in place to respond to acute changes in a patient's condition. In high-stress situations like RR, medical residents face decision-making challenges due to time constraints and perceived pressure. Instituting order panels (OPs) can facilitate clinical decision making and improve residents' and nurses' satisfaction and patient safety.
This quality improvement (QI) project aimed to create and institute standardized OPs for common RR clinical scenarios to improve satisfaction of internal medicine residents and nurses with the RR process.
This was a single tertiary care center QI project that developed OPs for 10 common RR scenarios. Resident and nursing satisfaction with RR was assessed before and after OP implementation via survey and qualitative data collection.
Residents and nurses expressed high levels of satisfaction across various aspects of the RR process before and after OP implementation in both quantitative and qualitative analysis. Increased satisfaction was observed among residents regarding time spent placing orders (94%; = 0.02) and time spent correcting wrong orders (87%; = 0.03) after OP implementation. The nurses' survey revealed no statistically significant differences in satisfaction before and after the implementation of OPs regarding communication, collaboration, efficiency, and organization of the team.
The introduction of standardized OPs for RRs resulted in increased satisfaction among internal medicine residents in terms of order placement and correcting wrong orders. Nurse satisfaction based on survey responses remained neutral. Qualitative data from both groups demonstrated a positive impact on communication, efficiency, and teamwork.
医院需要建立快速反应（RR）系统，以应对患者病情的急性变化。在RR这种高压力情况下，住院医师由于时间限制和感知到的压力，面临决策挑战。制定医嘱模板（OPs）有助于临床决策，提高住院医师、护士的满意度以及患者安全。
本质量改进（QI）项目旨在为常见的RR临床场景创建并制定标准化的OPs，以提高内科住院医师和护士对RR流程的满意度。
这是一个单一三级医疗中心的QI项目，为10种常见的RR场景制定了OPs。通过调查和定性数据收集，在OPs实施前后评估住院医师和护士对RR的满意度。
在定量和定性分析中，住院医师和护士在OPs实施前后对RR流程的各个方面都表示高度满意。OPs实施后，住院医师在下达医嘱所花费的时间（94%；P = 0.02）和纠正错误医嘱所花费的时间（87%；P = 0.03）方面的满意度有所提高。护士的调查显示，在OPs实施前后，在沟通、协作、效率和团队组织方面的满意度没有统计学上的显著差异。
引入RR的标准化OPs使内科住院医师在下达医嘱和纠正错误医嘱方面的满意度提高。基于调查反馈的护士满意度保持中立。两组的定性数据都表明对沟通、效率和团队合作有积极影响。
