危重患儿院内转运实践现状及障碍因素的田野研究  

Current practice and barriers of the intra⁃hospital transport for critically ill children:A field study

作　　者：李阳 王颖雯 顾莺 陈伟明[3] 胡静 马健 金芸[3] 杨玉霞[3] 沈伟杰[3] 王文超 胡沈洁 缑兆阳 LI Yang;WANG Yingwen;GU Ying;CHEN Weiming;HU Jing;MA Jian;JIN Yun;YANG Yuxia;SHEN Weijie;WANG Wenchao;HU Shenjie;GOU Zhaoyang(School of Nursing,Fudan University,Shanghai,200032,China;Nursing Department,Children's Hospital of Fudan University,Shanghai,201102,China;Pediatric Intensive Care Unit,Children's Hospital of Fudan University,Shanghai,201102,China;Children's Hospital of Fudan University,Emergency Department,Shanghai,201102,China)

机构地区：[1]复旦大学护理学院,上海200032 [2]复旦大学附属儿科医院护理部,上海201102 [3]复旦大学附属儿科医院儿童重症监护病房,上海201102 [4]复旦大学附属儿科医院急诊科,上海201102

出　　处：《中国循证儿科杂志》2024年第4期287-293,共7页Chinese Journal of Evidence Based Pediatrics

基　　金：上海市卫生健康系统重点扶持学科项目:2023ZDFC0103。

摘　　要：背景少有对指南推荐意见依从性和实施障碍因素的研究。目的了解急诊科和PICU医护人员对《住院患儿实施院内转运临床实践指南(2023版)》(简称指南)的依从性及其障碍因素。设计田野研究。方法以复旦大学附属儿科医院(我院)急诊、PICU、普通病房3个部门为田野地,通过参与医护人员对危重患儿院内转运的实践,以田野笔记的方式描述我院急诊科或PICU执业的医护人员向普通病房单向转运的现况,分析指南推荐意见实施面临的障碍因素。基于指南第1~5条推荐意见,参考指南PICU至目标科室流程,转化为3个环节(转运前、转运中和到达转入科室)10项具体指标,通过描述性观察和访谈、焦点观察和选择性观察采集指标素材,采用题纲式分析法,从田野笔记逐篇提取基线数据,并分析具体指标的依从性和实施的障碍因素。主要结局指标依从指南第1~5条推荐意见的障碍因素。结果2024年1月1日至3月21日在我院对25名医护人员(急诊科7名护士,PICU 7名医生和11名护士)实施的49例次危重患儿院内转运进行了观察,从急诊科转运至PICU 10例次,从PICU转运至内科和外科病区分别为18和21例次。参与院内转运的25名医护人员,年龄(31.3±5.0)岁,49例次转运中,患儿年龄(70.0±48.6)月,平均转运时长(16.1±6.0)min,平均床旁交接时间(6.8±3.5)min。床旁交接中断11例次,在转运过程中记录到2起不良事件,分别为忘记携带鼻饲奶和患儿在转运途中发生呕吐。转运前、转运中和到达转入科室3个环节共涉及10个指标,基本符合指南推荐意见的为转运决策、安置患儿和提问3个指标;不完全符合指南推荐意见的为病情监测、电话沟通、转运规划3个指标;不符合指南推荐意见的为转运人员配备、设备和药品配备、评估与记录和病情交接4个指标;建议接纳患儿准备指标为指南推荐意见。指南实施面临的潜在障碍因素�Background Few studies have focused on the adherence to and implementation barriers of clinical practice guideline recommendations.Objective To assess compliance with the Clinical Practice Guidelines for Intra-Hospital Transport of Pediatric Patients(2023)among medical staff in the emergency department and PICU and to identify the implementation barriers.Design Field study Methods The research was carried out in the emergency department,PICU,and general wards of Children's Hospital of Fudan University.Through participation in the practice of medical staff during intra-hospital transport of critically ill children,field notes were used to describe the current situation of one-way transport from the emergency department or PICU to general wards,as well as to analyze the barriers to implementing recommendations in the guideline.Based on recommendations 1-5 of the guideline,the PICU-to-target-department process(Appendix 2G in the guideline),was divided into three phases(pre-transport,during transport,and upon arrival at the receiving department)and 10 specific indicators.Descriptive observation,interviews,focus observation,and selective observation were employed to collect data.A template analysis method was used to extract baseline data from the field notes and analyze compliance with specific indicators and barriers.Main outcome measures Barriers to adhering to recommendations of 1-5 in the guideline.Results From January 1st to March 21st,2024,49 intra-hospital transports of critically ill children involving 25 medical staff(7 emergency nurses,7 PICU doctors,and 11 PICU nurses)were observed.Ten transports were from the emergency department to the PICU,and 18 and 21 were from the PICU to internal and surgical wards,respectively.The 25 participating medical staff had an average age of 31.3±5.0 years,and the children transported(49 cases)had an average age of 70.0±48.6 months.The average transport time was 16.1±6.0 minutes,with an average bedside handoff time of 6.8±3.5 minutes.Bedside handoffs were interrupted in

关 键 词：儿童 院内转运 田野研究 障碍因素分析 

分 类 号：R473.72[医药卫生—护理学]