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为重症患者实施医院内转运准备(IHT)与管理项目:运用实施研究整合框架(CFIR)识别障碍与促进因素——一项定性研究

Implementing an intrahospital transport preparation (IHT) and management project for critically ill patients: identification of barriers and facilitators using consolidated framework for implementation research (CFIR) - a qualitative study.

作者信息

Wang Jing, Zhang Xiaotian, Li Guifen, Lu Ying, Xie Rui, Cui Man, Li Baohua, Du Lanfang, Ma Li

机构信息

Department of Emergency, Peking University Third Hospital, Beijing, China.

Department of Nursing, Peking University Third Hospital, Beijing, China.

出版信息

BMJ Open. 2025 Jan 20;15(1):e096290. doi: 10.1136/bmjopen-2024-096290.

Abstract

OBJECTIVE

To investigate the factors contributing to or hindering intrahospital transport preparation and management projects using the consolidated framework for implementation research (CFIR) framework.

DESIGN

Semistructured interviews were used in a qualitative descriptive study.

SETTING

This study was conducted in the emergency room of a tertiary hospital in Beijing, China, between December 2023 and January 2024.

PARTICIPANTS

Purposive sampling was employed to recruit 22 doctors and nurses involved in intrahospital transport.

PRIMARY AND SECONDARY OUTCOME MEASURES

A content analysis technique was employed to transcribe and analyse all gathered data. Iterative methods were used for the data collection and analysis.

RESULTS

39 implementation determinants-11 barriers, 25 facilitators and 3 neutral factors-were identified. These determining factors aligned with 23 of the 26 CFIR constructs and 5 CFIR domains. Facilitators were identified in four primary domains: ease of implementation, scientific and project completion, patient advantages and enhanced capacity for safe and professional transfer. Additionally, hurdles were identified in the CFIR domains of intervention characteristics, outer settings and inner settings. These barriers include inadequate training and mobilisation, insufficient information systems, unclear reward and punishment policies, a shortage of labour and material resources and the absence of established reward and punishment laws.

CONCLUSION

This study identified the factors influencing the emergency department's intrahospital transport planning and management project implementation. Despite numerous obstacles, the project provides a clear pathway for advancing intrahospital transport planning and management.

摘要

目的

运用实施研究综合框架(CFIR)来调查促成或阻碍医院内转运准备及管理项目的因素。

设计

在一项定性描述性研究中采用半结构化访谈。

背景

本研究于2023年12月至2024年1月在中国北京一家三级医院的急诊科开展。

参与者

采用目的抽样法招募了22名参与医院内转运的医生和护士。

主要和次要结局指标

采用内容分析技术对所有收集到的数据进行转录和分析。数据收集和分析采用迭代方法。

结果

确定了39个实施决定因素——11个障碍因素、25个促进因素和3个中性因素。这些决定因素与CFIR的26个构建要素中的23个以及5个CFIR领域相符。在四个主要领域中确定了促进因素:易于实施、科学与项目完成、患者优势以及增强安全和专业转运能力。此外,在CFIR的干预特征、外部环境和内部环境领域中发现了障碍。这些障碍包括培训和动员不足、信息系统不完善、奖惩政策不明确、劳动力和物资资源短缺以及缺乏既定的奖惩法律。

结论

本研究确定了影响急诊科医院内转运规划和管理项目实施的因素。尽管存在诸多障碍,但该项目为推进医院内转运规划和管理提供了明确途径。

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