Burrowes Shana A, Jones Kayla C, Williams Christopher J, Neri Caitlin M, Klings Elizabeth S, Bellamy Scarlett L, Walkey Allan J, Drainoni Mari-Lynn, Cohen Robyn T
Section of Infectious Diseases, Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.
Department of Medicine, Evans Center for Implementation and Improvement Sciences, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA.
J Hosp Med. 2025 Jul 17. doi: 10.1002/jhm.70137.
In 2017 Boston Medical Center's (BMC) general pediatric inpatient unit implemented bi-level positive airway pressure (BiPAP) as supportive noninvasive ventilation for acute chest syndrome prevention (SNAP) to prevent adverse respiratory outcomes among medically stable, hospitalized patients with sickle cell disease. Barriers and facilitators to SNAP implementation at BMC differ from those in other settings.
To examine contextual determinants of SNAP implementation across different settings.
We conducted semi-structured interviews with inpatient clinicians at three sites (Site 1: extensive implementation, Site 2: limited implementation, Site 3: not implemented) about factors that would affect SNAP implementation. Interviews and analysis were guided by the Promoting Action on Research Implementation in Health Services (PARiHS) framework.
We interviewed 29 healthcare workers (physicians, nurses, physician assistants, child life specialists, respiratory therapists and psychologists). Five major themes emerged: (1) Communication between staff, particularly between the night and day shift, is critical for BiPAP initiation and success. (2) Nurses are key to successful SNAP implementation. (3) SNAP implementation requires multidisciplinary support, including integration of respiratory therapists and child life. (4) Individual unit level size, culture and workflow influence implementation (5) Hospital resources and leadership support are important for SNAP implementation.
Successful SNAP implementation across different contexts will require optimized communication between healthcare team members and the integration of respiratory therapy and child life early in the process of BiPAP initiation. Adapting to the unique features of each institution will be critical.
2017年，波士顿医疗中心（BMC）的普通儿科住院病房采用双水平气道正压通气（BiPAP）作为预防急性胸部综合征（SNAP）的支持性无创通气，以预防病情稳定的镰状细胞病住院患者出现不良呼吸结局。BMC实施SNAP的障碍和促进因素与其他环境不同。
研究不同环境下SNAP实施的背景决定因素。
我们对三个地点（地点1：广泛实施，地点2：有限实施，地点3：未实施）的住院临床医生进行了半结构化访谈，了解影响SNAP实施的因素。访谈和分析以卫生服务研究实施促进行动（PARiHS）框架为指导。
我们采访了29名医护人员（医生、护士、医师助理、儿童生活专家、呼吸治疗师和心理学家）。出现了五个主要主题：（1）工作人员之间的沟通，尤其是夜班和白班之间的沟通，对BiPAP的启动和成功至关重要。（2）护士是SNAP成功实施的关键。（3）SNAP的实施需要多学科支持，包括呼吸治疗师和儿童生活的整合。（4）各单位的规模、文化和工作流程会影响实施情况。（5）医院资源和领导支持对SNAP的实施很重要。
在不同背景下成功实施SNAP需要医疗团队成员之间优化沟通，并在BiPAP启动过程中尽早整合呼吸治疗和儿童生活。适应每个机构的独特特征至关重要。
