Network Analysis of Team Structure in the Neonatal Intensive Care Unit
Network Analysis of Team Structure in the Neonatal Intensive Care Unit
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DOI：
10.1542/peds.2009-2621
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发表时间：
2010-06-01
期刊：
影响因子：
8
通讯作者：
Chawla, Nitesh V.
中科院分区：
文献类型：
--
作者：
Gray, James E.;Davis, Darcy A.;Chawla, Nitesh V.
目的：研究护理团队结构及其与家庭满意度的关系。方法：利用电子健康档案建立以病人为基础的单模护理交接网络。在这些网络中，护士被表示为节点，切换被表示为边。对于每个患者，我们计算了网络统计数据，包括团队大小和直径、网络中心性指数、根据住院日新来者与护理团队的比例，以及一种新的衡量重复照顾者之间的平均轮班数量的指标，该指标旨在量化护理连续性。结果：团队规模随着住院时间的增加而增加。在两周大时，50%的轮班由一名新来的护士组成，该护士以前没有照顾过指示患者。新加入团队的人的模式并没有因出生体重而异。当根据平均重复照顾者间隔值对人群进行二分法时，熟悉护士的人员配备不太一致的情况下，护理问题的报告增加。在控制了出生体重、住院时间和团队规模等因素后，这种关系持续存在。结论：家庭对护理质量的感知与团队结构和护理参与顺序的相关性比团队规模更大。目的应用网络分析技术对电子健康档案中包含的信息进行分析，以衡量医疗团队的结构和功能。儿科2010；125：e1460-e1467
OBJECTIVE: The goal was to examine nursing team structure and its relationship with family satisfaction.METHODS: We used electronic health records to create patient-based, 1-mode networks of nursing handoffs. In these networks, nurses were represented as nodes and handoffs as edges. For each patient, we calculated network statistics including team size and diameter, network centrality index, proportion of newcomers to care teams according to day of hospitalization, and a novel measure of the average number of shifts between repeat caregivers, which was meant to quantify nursing continuity. We assessed parental satisfaction by using a standardized survey.RESULTS: Team size increased with increasing length of stay. At 2 weeks of age, 50% of shifts were staffed by a newcomer nurse who had not previously cared for the index patient. The patterns of newcomers to teams did not differ according to birth weight. When the population was dichotomized according to median mean repeat caregiver interval value, increased reports of problems with nursing care were seen with less-consistent staffing by familiar nurses. This relationship persisted after controlling for factors including birth weight, length of stay, and team size.CONCLUSIONS: Family perceptions of nursing care quality are more strongly associated with team structure and the sequence of nursing participation than with team size. Objective measures of health care team structure and function can be examined by applying network analytic techniques to information contained in electronic health records. Pediatrics 2010; 125: e1460-e1467