The Impact of Hospital Capacity Strain: a Qualitative Analysis of Experience and Solutions at 13 Academic Medical Centers.
The Impact of Hospital Capacity Strain: a Qualitative Analysis of Experience and Solutions at 13 Academic Medical Centers.
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DOI：
10.1007/s11606-021-07106-8
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发表时间：
2022-05
影响因子：
5.7
通讯作者：
Burden M
中科院分区：
文献类型：
--
作者：
Arogyaswamy S;Vukovic N;Keniston A;Apgar S;Bowden K;Kantor MA;Diaz M;McBeth L;Burden M
医院容量紧张会影响护理质量和医院吞吐量，还可能影响临床工作人员和团队的福祉以及他们的工作能力。各机构实施了一系列广泛的策略来帮助管理医院容量紧张，并取得了不同程度的成功。通过定性访谈，我们的研究探讨了用于解决医院能力紧张的干预措施和这些干预措施的感知影响，以及医院能力紧张如何影响患者、劳动力和其他机构优先事项。定性研究于 2019 年 6 月 21 日至 2019 年 8 月 22 日（COVID-19 之前）在美国 13 个大型城市学术医疗中心进行半结构化访谈。采访内容被记录、专业逐字转录、编码，然后在语义层面使用归纳和演绎混合的方法进行分析。确定了半结构化访谈的主题和副主题。采访了二十九名住院医师领导和医院领导。在 13 个站点中，实施了多种提供者、护理团队和机构策略，并取得了不同程度的成功。虽然医院领导和医院领导之间存在一些共识，但对于所部署的各种策略的成功程度也存在一些分歧。我们发现了三个主题：（1）医院能力紧张复杂且难以预测，（2）在面临压力时被认为最有效的干预措施是确保适当的资源；然而，通常采用成本较低的解决方案，这可能会导致意想不到的负面后果，(3) 医院能力紧张和部署的策略可能会对劳动力产生负面影响，并可能导致冲突。虽然各机构采用了许多不同的策略来管理医院容量紧张，并将其视为优先事项，但被视为具有最高收益的策略往往不是首先采用的。在线版本包含可在 10.1007/s11606-021-07106-8 获取的补充材料。
Hospital capacity strain impacts quality of care and hospital throughput and may also impact the well being of clinical staff and teams as well as their ability to do their job. Institutions have implemented a wide array of tactics to help manage hospital capacity strain with variable success. Through qualitative interviews, our study explored interventions used to address hospital capacity strain and the perceived impact of these interventions, as well as how hospital capacity strain impacts patients, the workforce, and other institutional priorities. Qualitative study utilizing semi-structured interviews at 13 large urban academic medical centers across the USA from June 21, 2019, to August 22, 2019 (pre-COVID-19). Interviews were recorded, professionally transcribed verbatim, coded, and then analyzed using a mixed inductive and deductive method at the semantic level. Themes and subthemes of semi-structured interviews were identified. Twenty-nine hospitalist leaders and hospital leaders were interviewed. Across the 13 sites, a multitude of provider, care team, and institutional tactics were implemented with perceived variable success. While there was some agreement between hospitalist leaders and hospital leaders, there was also some disagreement about the perceived successes of the various tactics deployed. We found three main themes: (1) hospital capacity strain is complex and difficult to predict, (2) the interventions that were perceived to have worked the best when facing strain were to ensure appropriate resources; however, less costly solutions were often deployed and this may lead to unanticipated negative consequences, and (3) hospital capacity strain and the tactics deployed may negatively impact the workforce and can lead to conflict. While institutions have employed many different tactics to manage hospital capacity strain and see this as a priority, tactics seen as having the highest yield are often not the first employed. The online version contains supplementary material available at 10.1007/s11606-021-07106-8.
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