Benjamin Ellen, Giuliano Karen K
Elaine Marieb College of Nursing, University of Massachusetts Amherst, Amherst, MA, United States.
Donna M and Robert J Manning College of Nursing and Health Sciences, University of Massachusetts Boston, 100 Morrissey Blvd, Boston, MA, 02125, United States, 1 6172875000.
JMIR Hum Factors. 2024 Dec 10;11:e60176. doi: 10.2196/60176.
Emergency nurses actively manage the flow of patients through emergency departments. Patient flow management is complex, cognitively demanding work that shapes the timeliness, efficiency, and safety of patient care. Research exploring nursing patient flow management is limited. A comprehensive analysis of emergency nursing work systems is needed to improve patient flow work processes.
The aim of this paper is to describe the work system factors that impact emergency nurse patient flow management using the System Engineering Initiative for Patient Safety model.
This study used grounded theory methodologies. Data were collected through multiple rounds of focus groups and interviews with 27 emergency nurse participants and 64 hours of participant observation across 4 emergency departments between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing. Emergent themes were organized according to the first component of the System Engineering Initiative for Patient Safety model, the work system.
Patient flow management is impacted by diverse factors, including personal nursing characteristics; tools and technology; external factors; and the emergency department's physical and socio-organizational environment. Participants raised concerns about the available technology's functionality, usability, and accessibility; departmental capacity and layout; resource levels across the health care system; and interdepartmental teamwork. Other noteworthy findings include obscurity and variability across departments' staff roles titles, functions, and norms; the degree of provider involvement in patient flow management decisions; and management's enforcement of timing metrics.
There are significant barriers to the work of emergency patient flow management. More research is needed to measure the impact of these human factors on patient flow outcomes. Collaboration between health care administrators, human factors engineers, and nurses is needed to improve emergency nurse work systems.
急诊护士积极管理患者在急诊科的流动情况。患者流动管理是一项复杂且对认知要求较高的工作，它塑造了患者护理的及时性、效率和安全性。探索护理患者流动管理的研究有限。需要对急诊护理工作系统进行全面分析，以改善患者流动工作流程。
本文旨在使用患者安全系统工程倡议模型描述影响急诊护士患者流动管理的工作系统因素。
本研究采用扎根理论方法。在2022年8月至2023年2月期间，通过多轮焦点小组讨论和对27名急诊护士参与者的访谈以及在4个急诊科进行的64小时参与观察收集数据。使用编码、持续比较分析和撰写备忘录的方法对数据进行分析。根据患者安全系统工程倡议模型的第一个组成部分即工作系统，对浮现的主题进行组织。
患者流动管理受到多种因素的影响，包括个人护理特征；工具和技术；外部因素；以及急诊科的物理和社会-组织环境。参与者对现有技术的功能、可用性和可及性；科室容量和布局；医疗保健系统的资源水平；以及跨部门团队合作表示担忧。其他值得注意的发现包括各科室工作人员角色头衔、职能和规范的模糊性和变异性；提供者参与患者流动管理决策的程度；以及管理层对时间指标的执行情况。
急诊患者流动管理工作存在重大障碍。需要更多研究来衡量这些人为因素对患者流动结果的影响。医疗保健管理人员、人为因素工程师和护士之间需要开展合作，以改善急诊护士工作系统。
