首页    期刊浏览 2024年11月08日 星期五
登录注册

文章基本信息

  • 标题:Breaking down walls: a qualitative evaluation of perceived emergency department delays for patients transferred with ST-elevation myocardial infarction
  • 本地全文:下载
  • 作者:Michael J. Ward ; Timothy J. Vogus ; Kemberlee Bonnet
  • 期刊名称:BMC Emergency Medicine
  • 印刷版ISSN:1471-227X
  • 电子版ISSN:1471-227X
  • 出版年度:2020
  • 卷号:20
  • 期号:1
  • 页码:1-10
  • DOI:10.1186/s12873-020-00355-6
  • 出版社:BioMed Central
  • 摘要:Despite regionalization efforts, delays at transferring hospitals for patients transferred with ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PCI) persist. These delays primarily occur in the emergency department (ED), and are associated with increased mortality. We sought to use qualitative methods to understand staff and clinician perceptions underlying these delays. We conducted semi-structured interviews at 3 EDs that routinely transfer STEMI patients to identify staff perceptions of delays and potential interventions. Interviews were recorded, transcribed, coded, and analyzed using an iterative inductive-deductive approach to build and refine a list of themes and subthemes, and identify supporting quotes. We interviewed 43 ED staff (staff, nurses, and physicians) and identified 3 major themes influencing inter-facility transfers of STEMI patients: 1) Processes, 2) Communication; and 3) Resources. Standardized processes (i.e., protocols) reduce uncertainty and can mobilize resources. Use of performance benchmarks can motivate staff but are frequently focused on internal, not inter-organizational performance. Direct use ofcommunication between ORGANIZATIONS can process uncertainty and expedite care. Record sharing and regular post-transfer communication could provide opportunities to discuss and learn from delays and increase professional satisfaction. Finally, characteristics of resources that enhanced their capacity, clarity, experience, and reliability were identified as contributing to timely transfers. Processes, communication, and resources were identified as modifying inter-facility transfer timeliness. Potential quality improvement strategies include ongoing updates of protocols within and between organizations to account for changes, enhanced post-transfer feedback between organizations, shared medical records, and designated roles for coordination.
  • 关键词:ST-elevation myocardial infarction;Inter-facility transfer;Emergency medicine;Care coordination;Qualitative methods
国家哲学社会科学文献中心版权所有