Work Systems Analysis of Emergency Nurse Patient Flow Management Using the Systems Engineering Initiative for Patient Safety Model: Applying Findings From a Grounded Theory Study.

IF 2.6 Q2 HEALTH CARE SCIENCES & SERVICES
JMIR Human Factors Pub Date : 2024-12-10 DOI:10.2196/60176
Ellen Benjamin, Karen K Giuliano
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引用次数: 0

Abstract

Background: 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.

Objective: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

使用病人安全模型的系统工程倡议对急诊护士病人流程管理的工作系统分析:应用扎根理论研究的结果。
背景:急诊护士积极管理通过急诊科的病人流量。患者流程管理是一项复杂的、需要认知能力的工作,它决定了患者护理的及时性、效率和安全性。关于护理病人流程管理的研究有限。需要对急诊护理工作系统进行全面分析,以改善患者流程工作流程。目的:本文的目的是描述工作系统的因素,影响急诊护士病人流程管理使用系统工程倡议病人安全模型。方法:本研究采用扎根理论方法。通过多轮焦点小组和对27名急诊护士参与者的访谈,以及在2022年8月至2023年2月期间对4个急诊科进行64小时的参与者观察,收集了数据。数据分析采用编码、持续比较分析和备忘录撰写。紧急主题是根据患者安全模型系统工程倡议的第一个组成部分,即工作系统来组织的。结果:患者流程管理受多种因素影响,包括个人护理特点;工具和技术;外部因素;以及急诊科的物理和社会组织环境。与会者提出了对现有技术的功能、可用性和可访问性的关注;部门容量和布局;整个卫生保健系统的资源水平;以及跨部门的团队合作。其他值得注意的发现包括部门员工角色、头衔、职能和规范的模糊性和可变性;提供者参与病人流程管理决策的程度;以及管理层对时间指标的执行。结论:急诊病人流程管理工作存在较大障碍。需要更多的研究来衡量这些人为因素对患者流量结果的影响。需要卫生保健管理人员、人为因素工程师和护士之间的合作来改进急诊护士工作系统。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
JMIR Human Factors
JMIR Human Factors Medicine-Health Informatics
CiteScore
3.40
自引率
3.70%
发文量
123
审稿时长
12 weeks
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